Initial prognostic factors and lymphoblast-erythrocyte rosette formation in 109 children with acute lymphoblastic leukemia.
Initial prognostic factors and lymphoblast-erythrocyte rosette formation in 109 children with acute lymphoblastic leukemia.
复制标题
109 例急性淋巴细胞白血病儿童的初始预后因素和淋巴细胞-红细胞玫瑰花结形成。
作者：
L. Dow;L. Borella;L. Sen;R. Aur;S. George;A. Mauer;J. Simone
对109例未经治疗的急性淋巴细胞白血病（ALL）患儿的骨髓淋巴母细胞进行了绵羊红细胞自发花环形成试验。26名儿童（24%）的淋巴母细胞形成了红细胞（E+）。在13个初始临床特征中，8个与E+淋巴母细胞显著相关：纵隔肿大（86%的患者E+），白细胞计数超过100 × 10（9）/升（65% E+），任何直径的结节大于2 cm（65% E+），年龄超过5岁（46% E+），血红蛋白超过8 g/dl（44% E+），大于5 cm的肝肿大（38% E+）、男孩（35% E+）和颈部区域外的淋巴结肿大（28% E+）。脾脏大小、初始血小板计数和高碘酸Schiff评分不能区分E+和E-患者。由于少数患者为黑人，少数患者患有中枢神经系统白血病，因此无法确定这两个特征与E+原始细胞的相关性。分层分类方案和线性逻辑回归模型被用来定义与E+淋巴母细胞相关的特征模式。E+患者的初始临床特征和较差的病程表明ALL包括至少两种生物学和临床上不同的类型。E+ ALL可能由非霍奇金淋巴瘤的白血病转化引起。
Bone marrow lymphoblasts from 109 children admitted with untreated acute lymphoblastic leukemia (ALL) were tested for spontaneous rosette formation with sheep erythrocytes. Twenty-six children (24%) had lymphoblasts that formed rosettes (E+). Of 13 initial clinical characteristics, 8 were significantly associated with E+ lymphoblasts: mediastinal enlargement (86% of patients E+), leukocyte counts over 100 X 10(9)/liter (65% E+), nodes greater than 2 cm in any diameter (65% E+), age over 5 yr (46% E+), hemoglobin over 8 g/dl (44% E+), hepatomegaly greater than 5 cm (38% E+), boys (35% E+), and lymph node enlargement outside of the cervical area (28% E+). Spleen size, initial platelet counts, and periodic acid-Schiff scores did not distinguish E+ from E- patients. Since few patients were black and few presented with central nervous system leukemia, the association of these two characteristics with E+ blasts could not be determined. A hierarchical classification scheme and a linear logistic regression model were used to define the patterns of characteristics associated with E+ lymphoblasts. The initial clinical characteristics and the poorer course of E+ patients suggest that ALL comprises at least two biologically and clinically distinct types. The E+ ALL may result from a leukemic transformation of a non-Hodgkin lymphoma.