Acute mixed lineage leukemia: clinicopathologic correlations and prognostic significance.
Acute mixed lineage leukemia: clinicopathologic correlations and prognostic significance.
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DOI：
10.1182/blood.v66.5.1115.1115
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发表时间：
1985
期刊：
影响因子：
20.3
通讯作者：
Mirro;Theodore F. Zipf;C. Pui;Geoffrey R. Kitchingman;DorothyL. Williams;S. Melvin;Sharon B. Murphy;Sanford A. Stass
中科院分区：
文献类型：
--
作者：
Mirro;Theodore F. Zipf;C. Pui;Geoffrey R. Kitchingman;DorothyL. Williams;S. Melvin;Sharon B. Murphy;Sanford A. Stass
使用一组谱系相关标志物在123名连续儿童中确定了同时显示淋巴和骨髓特征的急性白血病的频率和临床意义。根据标准诊断标准诊断为急性淋巴细胞白血病（ALL）的95名儿童中有18名（19%）的白血病原始细胞表达髓系相关细胞表面抗原。尽管有淋巴分化的免疫学证据（17例CALLA +和1例T细胞相关抗原+）和免疫球蛋白基因重排的发现，但这些患者的原始细胞与1至5种识别骨髓相关细胞表面抗原的单克隆抗体（My-1、MCS.2、Mo 1、SJ-D1或5 F1）反应。微球结合抗体的双重染色和流式细胞术分析证实，一些原始细胞同时表达淋巴和骨髓相关抗原。相反，28例急性非淋巴细胞性白血病（ANLL）患者中有7例（25%）的原始细胞表达淋巴细胞相关表面抗原，这些患者通过其他标准形态学和细胞化学标准进行诊断。单个胚细胞的双重染色显示髓过氧化物酶（MPO）（包括奥尔杆）与T-11、CALLA或末端脱氧核苷酸转移酶同时表达。一名ANLL患者的原始细胞表现出T细胞受体基因重排，而另一名患者的原始细胞表现出与T（T-11）、B（CALLA和重链免疫球蛋白基因重排）和髓系（MPO）谱系相关的特征。没有一致的细胞遗传学异常，没有患者表现出独立的白血病克隆。除骨髓相关抗原外，每例典型ALL患者在常规ALL诱导治疗后均达到完全缓解。相比之下，7例母细胞表达T-11表面抗原的ANLL患儿中有3例ANLL诱导治疗失败。这3例患者随后通过ALL治疗获得缓解。
The frequency and clinical significance of acute leukemia displaying both lymphoid and myeloid characteristics was determined in 123 consecutive children using a panel of lineage-associated markers. The leukemic blasts from 18 of 95 children (19%) with the diagnosis of acute lymphoblastic leukemia (ALL) by standard diagnostic criteria expressed myeloid-associated cell surface antigens. Despite immunological evidence of lymphoid differentiation (17 CALLA + and one T cell-associated antigen +) and findings of immunoglobulin gene rearrangement, blasts from these patients reacted with one to five monoclonal antibodies identifying myeloid-associated cell surface antigens (My-1, MCS.2, Mo1, SJ-D1, or 5F1). Dual staining with microsphere-conjugated antibodies and analysis by flow cytometry confirmed that some blasts were simultaneously expressing lymphoid- and myeloid-associated antigens. Conversely, blasts from seven of 28 patients (25%) with acute nonlymphocytic leukemia (ANLL), diagnosed by otherwise standard morphological and cytochemical criteria, expressed lymphoid-associated surface antigens. Dual staining of individual blasts demonstrated simultaneous expression of myeloperoxidase (MPO) (including Auer rods) in association with either T-11, CALLA, or terminal deoxynucleotidyl transferase. Blasts from one patient with ANLL demonstrated T cell receptor gene rearrangement, while blasts from another patient demonstrated characteristics associated with T (T-11), B (CALLA and heavy-chain immunoglobulin gene rearrangement), and myeloid (MPO) lineage. There were no consistent cytogenetic abnormalities, and no patient demonstrated independent leukemic clones. Each patient with typical ALL, except for myeloid-associated antigens, achieved complete remission with conventional induction therapy for ALL. By contrast, three of the seven children with ANLL whose blasts expressed the T-11 surface antigen failed ANLL induction therapy. These three patients subsequently achieved remission with ALL therapy.