错译表达髓系和淋系相关抗原急性白血病患者异质性生物学特征和预后的相关因素分析
|
摘要
目的:分析错译表达淋系与髓系相关抗原急性白血病(AL)患者异质性生物学特征和预后的相关因素。方法:本院收治的伴有错译表达淋系与髓系相关抗原的AL患者214例,根据其免疫表型进行分组,分析患者异质性生物学特征及预后的影响因素,并通过绘制生存曲线分析患者的生存状况。结果:214例患者中,免疫表型以髓系、B系抗原交叉表达为主(118例),其次是髓系、T系抗原交叉表达(88例),而髓系、T系与B系抗原交叉表达较少(仅有8例)。在急性淋巴细胞白血病(ALL)合并髓系抗原交叉表达的患者中,以CD33为主;在急性髓细胞白血病(AML)合并淋系抗原表达的患者中,T系抗原以CD7为主,而B系抗原以CD19为主。214例患者中,30例CD56和髓系抗原交叉表达; 6例患者为CD7、CD19和CD34交叉表达,4例患者为CD7、CD34和CD56交叉表达。在AML合并淋系抗原表达患者中,重现性染色体异常16例; ALL伴有髓系抗原表达的患者中,重现性染色体异常10例。26例重现性染色体异常的患者均存在错译抗原表达,伴有髓系抗原表达的ALL患者以错译CD33和CD13为多见,而AML伴有淋系抗原表达的患者以错译CD2、CD56及CD19为多见。相比不伴淋系抗原表达的患者,合并错译抗原表达的CD7、CD34阳性者生存率明显降低(均P <0. 05)。经Logistic回归分析结果显示,CD7、CD34是AL患者预后的主要影响因素(均P <0. 05)。结论:存在错译表达淋系与髓系相关抗原的AL是1种特殊白血病,其有着异质性生物学特征及独特的预后特点;临床中可通过流式细胞术对AL免疫表型进行检测,存在错译表达的分化抗原如CD7和CD34等是与AL患者预后相关的主要影响因素。
Objective: To analyze the heterogeneous biological characteristics of acute leukemia(AL) patients with mistranslation expressed lymphoid and myeloid-related antigens,and it's pro gnosis related factors. Methods : Two hundred and fourteen AL patiens with mistranslation expressed lymphoid and myeloid-related antigens were grouped according to immunophenotypes, and the heterogeneous biologic charecteristics and prognosis related factors were analyzed,moreover the survival curves were drawn to analyze the survival of patiens. Results: The immuno phenotype in 214 cases was mainly cross-ex pres si on of myeloid and B lineage antigen(118 cases),followed by cross-expression of myeloid antigen and T lineage(88 cases),while the cross-ex press ion of myeloid,T and B lineages, was less(only 8 cases). In ALL patiens with cross-expression of myeloid antigen, the CD33 was main type; while in AML patients with cross-expression of lymphoid antigen, CD7 was main type of lineage antigen, CD 19 was main type of B lineage antigen.Among 214 AL patients, the cross-expression of CD55 and myeloid antigen was found in 30 cases, the cross-expression of CD7, CD 19 and CD74 was observed in 6 cases, the cross-expressions of CD17 CD34 and CD56 was detected in 4 cases. Among AML patients with lymphoid antigen expression, the recurrent chromosmal abnormalities were found in 16 cases; among ALL patients with myeloid antigen expression, the recurrent chromosomal abnormalities were observed in10 cases. The mistranslation antigen expression existed in 26 patients with recurrent chromosomal abnormalities, the mistranslated CD33 and CD 13 in ALL patients with myeloid antigen expression was common, while the mistranslated CD2, CD56 and CD 19 in AML patients with lymphoid antigen expression was common. As compared with patients without lymphoid antigen expression, the survival rate decreased significantly in patients with mistranslated CD7( +)and CD34( +)(both P < 0. 05). The logistic regression analysis showed that CD7, CD34 were main influencing factors for prognosis of AL patients(both P <0. 05). Conclusion: The AL with mistranslation expressed lymphoid and myeloid antigens is a special kind of leukemia which possesses the heterogeneous biological characterists and unique prognosticfeatures, thus the immunophemotype of AL patients should be detected by flow cytometry. The existance of mistranlation-expressed differatiation antigens such as CD7 and CD34 is mainly influencing factors for the prognosis of AL patiens.
Objective: To analyze the heterogeneous biological characteristics of acute leukemia(AL) patients with mistranslation expressed lymphoid and myeloid-related antigens,and it's pro gnosis related factors. Methods : Two hundred and fourteen AL patiens with mistranslation expressed lymphoid and myeloid-related antigens were grouped according to immunophenotypes, and the heterogeneous biologic charecteristics and prognosis related factors were analyzed,moreover the survival curves were drawn to analyze the survival of patiens. Results: The immuno phenotype in 214 cases was mainly cross-ex pres si on of myeloid and B lineage antigen(118 cases),followed by cross-expression of myeloid antigen and T lineage(88 cases),while the cross-ex press ion of myeloid,T and B lineages, was less(only 8 cases). In ALL patiens with cross-expression of myeloid antigen, the CD33 was main type; while in AML patients with cross-expression of lymphoid antigen, CD7 was main type of lineage antigen, CD 19 was main type of B lineage antigen.Among 214 AL patients, the cross-expression of CD55 and myeloid antigen was found in 30 cases, the cross-expression of CD7, CD 19 and CD74 was observed in 6 cases, the cross-expressions of CD17 CD34 and CD56 was detected in 4 cases. Among AML patients with lymphoid antigen expression, the recurrent chromosmal abnormalities were found in 16 cases; among ALL patients with myeloid antigen expression, the recurrent chromosomal abnormalities were observed in10 cases. The mistranslation antigen expression existed in 26 patients with recurrent chromosomal abnormalities, the mistranslated CD33 and CD 13 in ALL patients with myeloid antigen expression was common, while the mistranslated CD2, CD56 and CD 19 in AML patients with lymphoid antigen expression was common. As compared with patients without lymphoid antigen expression, the survival rate decreased significantly in patients with mistranslated CD7( +)and CD34( +)(both P < 0. 05). The logistic regression analysis showed that CD7, CD34 were main influencing factors for prognosis of AL patients(both P <0. 05). Conclusion: The AL with mistranslation expressed lymphoid and myeloid antigens is a special kind of leukemia which possesses the heterogeneous biological characterists and unique prognosticfeatures, thus the immunophemotype of AL patients should be detected by flow cytometry. The existance of mistranlation-expressed differatiation antigens such as CD7 and CD34 is mainly influencing factors for the prognosis of AL patiens.
引文
1 Sharma RK,Purohit A,Somasundaram V,et al.Aberrant myeloid antigen co-expression is correlated with high percentages of CD34-positive cells among blasts of acute lymphoblastic leukemia patients:an Indian tertiary care center perspective.Blood Res,2014;49(4):241-245.
2赖剑平,曾长英,黄捷,等.急性淋巴细胞白血病髓系抗原表达的临床意义.中国基层医药,2013;20(22):3410-3412.
3王秋实,佟海侠,陆春伟,等.成人急性双表型白血病的临床和生物学特征研究.现代肿瘤医学,2014;22(3):645-648.
4李卫华,何慧清,牛晓敏,等.髓系抗原表达与成人急性淋巴细胞白血病预后的关系.广东医学,2013;34(7):2148-1080.
5 Arber DA,Orazi A,Hasserjian R,et al.The 2016 revision to the World Health Organization classification of myeloid neoplasms and acute leukemia.Blood,2016;127(20):2391-405.
6方芳,朱平,张英,等.227例急性髓系白血病跨系抗原表达的临床特征及预后意义.中国实验血液学杂志,2016;24(4):990-997.
7 Ehninger A,Kramer M,Rollig C,et al.Distribution and levels of cell surface expression of CD33 and CD 123 in acute myeloid leukemia.Blood Cancer J,2014;4(6):e218.
8张斌,蔡艳霞,张素贞,等.伴髓系抗原CD13高表达的急性B细胞白血病形态学及流式细胞学特点分析.白血病·淋巴瘤,2016;25(8):492-494.
9刘莎,魏旭东,米瑞华,等.CD56在t(8;21)成人急性髓系白血病患者中的表达及其与预后的相关性分析.中华血液学杂志,2015;36(8):676-681.
10 Wang Q,Wang Y,Lv H,et al.Treatment of CD33-directed chimeric antigen receptor-modified T cells in one patient with relapsed and refractory acute myeloid leukemia.MolTher,2015;23(1):184-191.
11杨璐璐,刘欣,李庆,等.急性髓系白血病免疫分型特点及与疗效相关性分析.中国实验血液学杂志,2014;22(1):1-5.
12 Sarma A,Hazarika M,Das D,et al.Expression of aberrant CD markers in acute leukemia:Astudy of 100 cases with immunophenotyping by multiparameter flowcytometry.Cancer Biomark,2015;15(4):501-505.
13张小芳,栗瑞敏,张运刚,等.急性双表型白血病细胞形态学和免疫表型的研究.国际检验医学杂志,2016;37(21):2999-3001.
14马瑞霞,叶芳,李国霞,等.急性髓系白血病108例免疫表型特征与临床预后分析.中国药物与临床,2013;13(2):147-150.
2赖剑平,曾长英,黄捷,等.急性淋巴细胞白血病髓系抗原表达的临床意义.中国基层医药,2013;20(22):3410-3412.
3王秋实,佟海侠,陆春伟,等.成人急性双表型白血病的临床和生物学特征研究.现代肿瘤医学,2014;22(3):645-648.
4李卫华,何慧清,牛晓敏,等.髓系抗原表达与成人急性淋巴细胞白血病预后的关系.广东医学,2013;34(7):2148-1080.
5 Arber DA,Orazi A,Hasserjian R,et al.The 2016 revision to the World Health Organization classification of myeloid neoplasms and acute leukemia.Blood,2016;127(20):2391-405.
6方芳,朱平,张英,等.227例急性髓系白血病跨系抗原表达的临床特征及预后意义.中国实验血液学杂志,2016;24(4):990-997.
7 Ehninger A,Kramer M,Rollig C,et al.Distribution and levels of cell surface expression of CD33 and CD 123 in acute myeloid leukemia.Blood Cancer J,2014;4(6):e218.
8张斌,蔡艳霞,张素贞,等.伴髓系抗原CD13高表达的急性B细胞白血病形态学及流式细胞学特点分析.白血病·淋巴瘤,2016;25(8):492-494.
9刘莎,魏旭东,米瑞华,等.CD56在t(8;21)成人急性髓系白血病患者中的表达及其与预后的相关性分析.中华血液学杂志,2015;36(8):676-681.
10 Wang Q,Wang Y,Lv H,et al.Treatment of CD33-directed chimeric antigen receptor-modified T cells in one patient with relapsed and refractory acute myeloid leukemia.MolTher,2015;23(1):184-191.
11杨璐璐,刘欣,李庆,等.急性髓系白血病免疫分型特点及与疗效相关性分析.中国实验血液学杂志,2014;22(1):1-5.
12 Sarma A,Hazarika M,Das D,et al.Expression of aberrant CD markers in acute leukemia:Astudy of 100 cases with immunophenotyping by multiparameter flowcytometry.Cancer Biomark,2015;15(4):501-505.
13张小芳,栗瑞敏,张运刚,等.急性双表型白血病细胞形态学和免疫表型的研究.国际检验医学杂志,2016;37(21):2999-3001.
14马瑞霞,叶芳,李国霞,等.急性髓系白血病108例免疫表型特征与临床预后分析.中国药物与临床,2013;13(2):147-150.