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目的探讨急性髓细胞性白血病微分化型的诊断和治疗。方法骨髓涂片作细胞化学分析。抗凝骨髓液用流式细胞单克隆抗体直接免疫标记技术检测白血病细胞表面相关抗原分化群 ,咐醇酯诱导分化试验 ,短期培养法直接法G显带分析白血病细胞染色体组型。用TA/HA/IdaA等方案化疗 ,达完全缓解 (CR)后作异基因外周血干细胞移植。结果骨髓增生极度活跃 2例 ,明显活跃 1例 ,活跃 1例 ,均未见Auer小体及嗜天青颗粒。早期微分化细胞NEC均 >90 % ,过氧化酶染色均阴性 ,糖元染色 2例弱阳性 ,2例阴性 ,非特异性酯酶染色 2例阳性 ,氟化钠不抑制。 1例咐醇酯诱导分化试验强阳性。免疫表型 3例CD+ 1 3,1例CD+ 1 5,1例CD+ 38,1例CD+ 1 1b,4例MPO弱阳性 ,CD1 9、CD2 均阴性 ,2例CD+ 7,白血病细胞染色体组型未见异常。 2例化疗达完全缓解 ,其中 1例现已存活 2 8月余 ;1例存活 1 9月 ,因合并肥厚心肌病放弃治疗 ,复发死亡。另 2例化疗无缓解 ,死亡 1例 ,自动出院 1例。结论细胞化学、细胞免疫表型是诊断急性髓细胞性白血病微分化型的重要依据 ,用AML方案治疗ANLL M0 有效。
Objective To investigate the differential diagnosis and treatment of acute myeloid leukemia. Methods Bone marrow smears were used for cytochemical analysis. Anticancer bone marrow fluid using flow cytometry monoclonal antibody direct immunolabeling detection of leukemia cell surface antigen-related differentiation group, alcohol ester induced differentiation test, short-term culture method of direct G-banding analysis of leukemia cell genome. With TA / HA / IdaA and other chemotherapy, up to complete remission (CR) after allogeneic peripheral blood stem cell transplantation. Results The bone marrow hyperplasia was extremely active in 2 cases, obviously active in 1 case and active in 1 case. No Auer bodies and azotathic granules were seen. Early differentiated cells NEC were> 90%, peroxidase staining were negative, glycogen staining in 2 cases weakly positive, 2 negative, non-specific esterase staining in 2 cases, sodium fluoride is not inhibited. A case of alcohol ester induced differentiation test strongly positive. Immunophenotype 3 CD + 1 3, 1 CD + 1 5, 1 CD + 38, 1 CD + 1 lb, 4 cases of MPO weakly positive, CD19, CD2 were negative, 2 CD + 7, leukemia cell genome type See abnormalities. 2 cases of complete remission of chemotherapy, of which 1 case has survived more than 28 months; 1 case of survival in September, due to the merger of hypertrophic cardiomyopathy to give up treatment, recurrence of death. The other two cases of chemotherapy without remission, 1 patient died, 1 patient was discharged automatically. Conclusions Cytochemistry and Cellular Immunophenotype are the important basis for the differential diagnosis of acute myeloid leukemia. The treatment of ANLL M0 with AML regimen is effective.