| Objective:(1)To analyze the immunophenotype of newly diagnosed acute promyeloc ytic leukemia (APL).(2) To ivestigate the correlations between the immunophenotyp es and the FAB morphological classification,the white blood cell count (WBC),plate let count (Pit),fibrinogen(Fg),the proportion of leukemia cells in the bone marrow,the fusion gene subtype and the incidence of retinoic acid syndrome (RAS).(3)To discuss the significance of the markers which were unnoticed relatively before in APL.Methods:1.Retrospective analysis was performed in the50patients with newly diag nosed APL cases in the past eight years,All patients came from the Department of Hematology of the First Affiliated Hospital of the Kunming Medical University. All the cases got a comprehensive MICM information.50patients were divided into two groups by the positive and the negative of all the immunophenotypes, We compared the differences between two groups in the M3a and M3b WBC,Plt,Fg,the proportion of myeloid leukemia cells in the bone marrow,the PML-RARa L/S/V fusion gene subtype,the treatment response to all-trans retinoic acid(ATRA)/arsenictrioxide and the presence of RAS.2.The CD117,CD38,andCD9were retrospectively analyzed.3.Th e correlations of results were analyzed by the chi-square test statistical analysis.Result:1.The positive rates of the immunophenotypes,include MPO,CD45,CD13,CD33,CD123,CD38,CD9, are higher than other markers in APL patients,Next are CD117,CD56,CD64,CD71.The average percentage of CD33positive cells(72.35%) is higher than CD13(64.09%), and the distribution of the CD33positive cell percentage is homogeneous, the distribution of CD13is diverse.No difference in age or gender were found in the33antigens we studied.2. Among the13patients of M3a with CD34detected, CD34+patients accounted for2cases,the positive rates is15.38, Among the14patients of M3b with CD34detected, CD34+patients accounted for5cases,the positive rates is35.71%.These showed that CD34+may be related with M3b.But to the chi-square test,chi-square value is0.59, P>0.05.The results showed that there were no statistically significant differrence in distribution of CD34positive patients on the FAB morphology classification.Among the21patients of M3a with HLA-DR detected,HLA-DR+patients accounted for2cases,the positive rates is9.52%.Among the14patients of M3b with HLA-DR detected, HLA-DR+patients accounted for6cases,the positive rates is42.86%.These showed that HLA-DR+may be related with M3b.But to the chi-square test,chi-square value is3.57, P>0.05.The results showed that there were no statistically significant difference in distribution of HLA-DR positive patients on the FAB morphology classification. CD34+or HLA-DR+may be related with M3b,but chi-square test shows that there were no statistically significant differences in distribution.3.These results showed that the average level of the WBC,among HLA-DR+group, CD34+group,were related with lower WBC,but CD34+HLA-DR+group,were more related with lower WBC to1.23X109/L.These showed that CD34+or HLA-DR+may be related with lower WBC, and CD34+HLA-DR+has much lower WBC. The Plt of HLA-DR+group including CD34+and CD34-is lower to27.75X109/L,and the Plt of single HLA-DR+is also lower to20.6X109/L.The Fg level of CD34+and HLA-DR+(Which were repectively1.35g/L and1.21g/L) were lower than the CD34-and HLA-DR-(Which were repectively1.81g/L and1.86g/L).In10%positive critical value,the proportion of PML-RARa L fusion gene subtype in CD34+was66.67%(2/3),S was16.67%(1/3),And the proportion of L subtype and S subtype in the CD34-was58.33%(7/12) and16.67%(2/12).The other3cases were negative,and the PML-RA Ra negative type were all attached to CD34-(including1case,which was detected to be V subtype in the detection of other hospital),and the proportion of CD34positive cell in L subtype and S subtype of CD34+, were repectively24.63%and12.65%, S subtype were more detected in CD34+In patients treated with ATRA, RAS appeared2cases of the4CD34+patients, RAS appeared4cases of the14CD34-patients, RAS appeared3cases of the6HLA-DR+patients, and RAS appeared4cases of the17HLA-DR-patients. The occurrence rate of RAS on CD34+or HLA-DR+were higher than their negative group.4. In the41patients of APL, whose CD117were detected,the average percenttage of CD117positive cells was47.35%.25cases of CD117positive cells proportion were higher than40%, accounting for60.98%of the total.13cases are higher than60%, accounting for31.71%of the total. Compared with the CD33, the distribution of CD117is diverse in APL patients.5. In the22patients of APL, whose CD38were detected,the positive rates and the average percentage of positive cells are all higher (81.82%and65.28%respectively).16cases of CD38positive cells proportion were higher than40%,accounting for72.73%of the total.13cases are higher than60%,accounting for59.09%.CD38positive rates and the average percentage of positive cells are all higher in APL,but the distribution of CD38is diverse.It is difficult to separate naive cells from mature cells.CD38+is possibility associated with RAS.6. In the29patients of APL, whose CD9were detected, the positive rates and the aver age percentage of positive cells are all higher(89.66%and66.30%respectively).22cases of CD9positive cells proportion are higher than40%, accounting for75.86%of the total.19cases are higher than60%,accounting for65.52%.CD9positive rates and the average percentage of positive cells in APL are all higher,and the distribution of CD9is homogeneous,it is easy to separate naive cells from mature cells.Conclusion:1.The positive rates of the immunophenotypes,include MPO,CD45,CD13, CD33,CD123,CD38,CD9, are higher than other markers in APL patients,Next are CD117,CD56,CD64,CD71. The average percentage of CD33positive cells is higher than CD13, and the distribution of the CD33positive cell percentage is homogeneou s, the distribution of CD13is diverse.Compared with the CD33, the distribution of CD117positive cells proportion is diverse.To patients,who are not high on the propor tion of positive cells, of newly diagnosed CD117,the use of CD117gating analysi s,may reduce the proportion of leukemia cells.2.CD34+or HLA-DR+may be related with M3b,but the chi-square test showed that there were no statistically significant differences in distribution,it is may be related with the small number of cases.The average level of the WBC,among single HLA-DR+group, single CD34+group,and CD34+HLA-DR+group,were repectively related with lower WBC,its significance is not clear. The Fg level of CD34+and HLA-DR+were lower than the CD34-and HLA-DR" CD34+and HLA-DR+may be more prone to bleeding, but the clinical hemorrhage showed no significant defference with each other. The proportion of PML-RARa S fusion gene subtype and the occurrence rate of RAS on CD34+or HLA-DR+were larger than their negative group.3.CD38positive rates and the average proportions of positive cells are all higher, but the distribution of the positive cell percentage is diverse.CD38+is possibility associat ed with RAS, this may be related to ATRA induced differentiation of leukemia cells by CD38+cells,lead to the occurrence of RAS.4. CD9positive rates and the average proportions of positive cells are all higher, the distribution of the positive cell percentage is homogeneous. |
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