慢性髓细胞白血病急变期MICM分型回顾性分析

目的：探讨慢性髓细胞白血病急变期（CML-Be）患者的细胞形态学（M）、免疫学（I）、细胞遗传学（C）和分子生物学（M）的特征及应用价值。方法：对38例CML．BC患者的MICM分型进行回顾性分析。结果：以FAB分型为基础的形态学确诊率达94．7％；免疫分型结果为：38例CML-BC中CML-AML占71．0％，其中37．0％伴淋系表达；CML-ALL占23．7％，均为B细胞性，其中66．67％伴髓系表达；CML-MAL（混合性白血病）占5．3％，均为B系和髓系混合表达；CD34＋26例（68．4％），cD7＋10例（26．3％），均与CD34共表达。细胞遗传学结果显示：CML特征性Ph染色体检出率为94．3％（36／38），附加异常染色体检出率为60．5％（23／38），发生频率较高的类型是＋Ph、＋8和i（17q）；FISH检测BCR／ABL融合基因阳性率为100％，der（9）缺失占14．7％。RT—PCR检测20例患者BCR／ABL融合基因均为阳性，其中b2a2型（12／20），b3a2型（8／20），1例（1／20），b2a2和b3a2双阳性（1／20）。结论：CML—BC是造血干细胞疾病，原始细胞分化阻滞在早期阶段，预后差。MICM分型对CML-BC的诊断、治疗和预后判断均有重要价值。

Analysis of Morphology, Immunology, Cytogentic and Molecular Biology Classification of Patients with Chronic Myeloid Leukemia in Blastic Crisis

Objective： To invistigate the characteristic and value of bone marrow morphology, immunology, cytogenetic and molecular biology （MICM） in patients with chronic myeloid leukemia in blastic crisis （CML-BC）. Methods： 38 patients with CML-BC were studied by MICM analysis. Results： The accuracy rate of morphological diagonis based on FBA classification was 94.7%. Immunology results, the percentage of CML-AMLwas 71.0%, in which 37.0% patients expressed lympholytic associated antigen; The percentage of CML-ALL was 23.7% and all were B lypholytic immunophenotype, in which 66.7% patients expressed myeloid assuiated antigen; The percentage of CML-MALwas 5.3% with all expressing B lypholoid and myeloid immumphenotype. 26 cases （68.4%） had CD34 expression and 10 cases （26.3%） had CD7 and CD34 Co-expression. In cytogenetic result, the positive rate of Ph chromosome was 94.3%. Other chromosome abnomality rate was 60.5% with ＋ph,＋8 and i （17q） in high appearance rate. The positive rate of BCR/ABL gene by FISH reached 100% with 14.7% del（9）. The positive rate ofBCR/ABLgene by RT-PCR also reached 100% with b2a3（12/20）,b3a2（8/20） and b2a3＋b3a2（1/20）. Conclusion： CML-BC is a kind of disease of stem cell. The differentiation of blast cell is blocked in the early stage. MICM has great value in diangnosis, therapy and prognosis judgement.