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目的探讨伴 AML-1/ETO 基因重排的急性髓细胞白血病 M_2型(AML-M_2)患者骨髓的多参数免疫表型特征及多参数免疫表型检测对此亚型的预测性。方法应用多参数流式细胞术分析30例经荧光原位杂交(FISH)检测 AML-1/ETO 融合基因阳性,FAB 分型为 AML-M_2(简称 M_2/ETO~+)患者骨髓的免疫表型,并与36例 FAB 分型为 AML-M_2、AML-1/ETO 融合基因检测为阴性(简称 M_2/ETO~-)和34例 FAB 分型为 AML-M_3(急性早幼粒细胞白血病,APL)患者的免疫表型进行比较。结果 30例 M_2/ETO~+患者骨髓中均可见一群原始细胞(15.89%～68.53%)和一群侧向散射(SSC)较高异质性、分化的粒细胞。原始细胞表达干细胞相关抗原 CD_(34)、HLA-DR 和髓系抗原 CD_(33)、CD_(13)、MPO,并显示特异的抗原表达模式。在 M_2/ETO~+患者中 CD_(33)表达的平均荧光强度显著低于M_2/ETO~-和 APL 患者(MFI 分别为98±75、244±184和845±523,P 均<0.01),CD_(19)(90.0%)和CD_(34)~+CD_(56)~+(100%)共表达的阳性率均显著高于 M_2/ETO~-(11.11%,25.0%)和 APL 患者(8.82%,0%),P 均<0.01,与 APL 比较 CD_9~+MPO~+的共表达率显著降低(0%vs.93.75%),而 HLA-DR 表达则显著升高(100%vs.27.27%)。M_2/ETO~+患者粒细胞表达分化的髓系抗原 CD_(11b)和 CD_(15),并可分为 CD_(15)~+CD_(11b)~-和 CD_(15)~+CD_(11b)~+两群,而成熟的粒细胞标志 CD_(10)均为阴性,并且81.48%M_2/ETO~+患者的粒细胞表达 CD_(56),显著高于 M_2/ETO~-患者(22.22%)和 APL 患者(17.56%)。结论伴 AML-1/ETO 基因重排的 AML-M_2型白血病具有独特的免疫表型,对其基因重排有较高的预测性。应用多参数免疫分型技术可较容易地将 M_2/ETO~+亚型白血病与 APL 鉴别。
Objective To investigate the multiparameter immunophenotypic characteristics of bone marrow of AML-1 / ETO gene rearranged patients with acute myeloid leukemia M_2 (AML-M_2) and the predictive value of multiparameter immunophenotypic test for this subtype. Methods The multi-parameter flow cytometry was used to analyze the immunophenotypes of 30 cases of AML-M 2 (M_2 / ETO ~ +) patients with positive AML-1 / ETO fusion gene by fluorescence in situ hybridization (FISH) (AML-M_3), AML-M_3 (acute promyelocytic leukemia, APL ) Patients with immunophenotype comparison. Results A group of primitive cells (15.89% -68.53%) and a group of highly heterogeneous and differentiated granulocytes with lateral scatter (SSC) were found in bone marrow of 30 patients with M_2 / ETO ~ +. The original cells expressed CD34 (34), HLA-DR, myeloid CD_ (33), CD_ (13) and MPO, and showed specific antigen expression patterns. The mean fluorescence intensity of CD_ (33) expression in M_2 / ETO ~ + patients was significantly lower than that in M_2 / ETO ~ - and APL patients (MFI 98 ± 75,244 ± 184 and 845 ± 523, respectively, P 0.01) The positive rates of CD_ (19) (90.0%) and CD_ (34) ~ + CD_ (56) ~ + (100%) were significantly higher than those of M_2 / ETO ~ (11.11%, 25.0% (P <0.01). Compared with APL, the co-expression rate of CD_9 ~ + MPO ~ + was significantly lower (0% vs.93.75%) than that of APL, while the expression of HLA- DR was significantly increased (100% vs. 27.27%). The myeloid antigens CD_ (11b) and CD_ (15) were expressed in granulocytes of M_2 / ETO ~ + patients and could be divided into CD_ (15) ~ + CD_ (11b) ~ and CD_ (15) ~ + CD_ ), And the mature granulocyte marker CD_ (10) was negative, and the expression of CD_ (56) in 81.48% M_2 / ETO ~ + patients was significantly higher than that in M_2 / ETO_ (22.22% ) And APL patients (17.56%). Conclusions AML-M 2 leukemia with AML-1 / ETO gene rearrangement has a unique immunophenotype and high predictive value for gene rearrangement. Application of multi-parameter immunophenotyping technology can be more easily identified M_ (2) / ETO ~ + subtype leukemia and APL.