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目的探讨儿童急性早幼粒细胞白血病(APL)治疗后转为急性单核细胞白血病(AML-M5)的细胞遗传学和分子遗传学机制。方法对1例急性早幼粒细胞白血病患儿的诊断、连续缓解和复发的整个过程应用细胞形态学、组织化学、细胞遗传学和分子遗传学方法进行监测。结果该患儿经骨髓细胞形态学、染色体以及融合基因检查确诊为APL,缓解期间PML/RARα融合基因始终阳性;完全缓解30个月后复发,而此时染色体恢复正常、PML/RARα融合基因转阴;细胞和分子遗传学检查示转型为AML-M5,转型后经再诱导治疗无效死亡。结论急性早幼粒细胞白血病治疗后转为急性单核细胞白血病为特殊复发形式,耐药性强,治疗效果差。其原因可能与白血病次级克隆扩增或药物诱导的克隆改变有关。
Objective To investigate the cytogenetics and molecular genetics of acute myeloid leukemia (AML-M5) in children with acute promyelocytic leukemia (APL). Methods The whole process of diagnosis, continuous remission and relapse in 1 patient with acute promyelocytic leukemia was monitored by morphological, histochemical, cytogenetic and molecular genetic methods. Results The children were diagnosed as APL by morphology, chromosomal and fusion gene examination of bone marrow cells, and the PML / RARα fusion gene was always positive during remission. The complete remission was achieved after 30 months and the chromosomes returned to normal. The PML / RARα fusion gene transfer Yin; cell and molecular genetic tests showed that the transformation of AML-M5, after re-induction therapy after death died. Conclusion The treatment of acute promyelocytic leukemia into acute monocytic leukemia as a special form of recurrence, drug resistance, poor treatment. The reason may be secondary to leukemia amplification or drug-induced clonal changes.