Application Of Flow Cytometry In M4、M5 Leukemia

Research background and purpose:Acute myeloid leukemia（AML）is one of the most common malignant tumors in China.It is of great significance to make accurate diagnosis,treatment and prognosis.With the rapid development of immunology and molecular biology,flow cytometry is particularly important in the diagnosis and typing of leukemia.A large number of clinical diagnostic studies have shown that flow cytometry is of great significance in the diagnosis and prognosis of leukemia.For example,patients expressing MPO/CD19antigen molecule have a good prognosis.This article will describe the common immunophenotypes of patients with acute myelomonocytic leukemia（type M₄）and acute monocytic leukemia（type M₅）,and analyze the correlation between antigen molecules and disease prognosis,which will help clinicians understand the value of flow cytometry immunotyping in the diagnosis and prognosis of patients with type M₄and M₅.Research objects and methods:This study collected the basic clinical information,laboratory examination,antigen molecule expression,treatment and disease remission of M₄ and M₅patients admitted to the Department of Hematology of our hospital from October 2012 to March2021.The application value of antigen molecules in differential expression,chemotherapy efficacy and prognosis of M₄ and M₅ patients was discussed to provide theoretical basis for clinical diagnosis and treatment.Statistical methods:The collected data were counted by SPSS 20.0 software.Chi square test or Fisher’s exact probability method was used for the four grid table of counting data.The statistical quantity P<0.05 was statistically significant between groupsResearch results:1.135 patients（64 AML-M₄,71 AML-M₅）were collected in this study.Among them,there were 73 males and 62 females,with a male to female ratio of 1.18:1.The age composition ratio of M₄ and M₅ patients in each group showed a trend that the incidence rate increased with the age of patients.2.The results of blood routine examination showed that in the platelet（>50x10^9/L,<100x10^9/L）group,the constituent ratio of M₅ patients was higher than that of M₄ patients（P=0.03）,and in the platelet（<50x10^9/l）group,the constituent ratio of M₄ patients was higher than that of M₅ patients（P=0.04）.M4 patients were more prone to thrombocytopenia,and there was no difference in other blood routine results.The results of liver and spleen infiltration showed that there was no significant difference between the two groups.The results of bone marrow hyperplasia showed that there was no significant difference in the degree of bone marrow hyperplasia among the groups（p>0.05）.3.By analyzing the number of antigen molecules,it was found that M₄ patients expressed the most CD33 molecules,followed by CD38 molecules,followed by CD117,HLA-DR,CD13 and CD123 antigen molecules.Type M₅ patients expressed the most CD38 molecules,followed by CD15,then CD11b,HLA-DR and CD117antigen molecules.By analyzing the difference of antigen molecules between M₄ and M₅ patients,it was found that the proportion of CD11b,CD14 and CD56 antigen molecules in M5 patients was significantly higher than that in M₄ patients,with statistical difference（P<0.05）.The constituent ratio of antigen molecules CD33,CD34,CD117 and MPO in M₅patients was significantly lower than that in M₄ patients（P<0.05）.4.The difference analysis of antigen molecular combination shows that the proportion of the number of patients with M₅ in the double positive group（CD11b+CD56+）is higher than that in the M₄ group.After statistics,it is found that P=0.001,and the expression of the double positive group（CD11b+CD56+）is more inclined to M₅ patients.The proportion of the number of antigen molecules in the double positive group（CD33+CD34+）and the double positive combined double negative group（CD33+CD34+CD11b-CD56-）in patients with type M₄ was significantly higher than that in patients with type M₅.The statistical difference between the double positive group and the double negative group was greater.Therefore,the expression of the double positive group（CD 33+CD34+）and the simultaneous expression of the double positive group（CD33+CD34+）and the double negative group（CD11b-CD56-）tended to be in patients with type M₄ leukemia.It is the key antigen combination molecule to distinguish M₄ and M₅ leukemia.5.By analyzing the expression of antigen molecules and prognosis of patients,it was found that there were 33 patients with M₄ type,and the complete remission rate of induced remission was 41.9%.There were 25 patients with M₅type,and the complete resolution rate of induced remission was 40%.After induced remission treatment,it was found that the complete remission rates of M₄ and M₅ patients were basically the same.By analyzing the expression of antigen molecules and the complete remission rate of induced remission therapy,it was found that the expression of antigen molecules CD11b,CD14,CD33,CD38,CD117 and MPO in M₄ patients had no clear correlation with the complete remission rate of induced remission therapy（P>0.05）.The unresponsive rate of M₄ leukemia with positive expression of CD34 antigen molecules was significantly higher than that in the negative group,indicating that the prognosis of M₄ patients with positive expression of CD34 was poor.There was no correlation between the expression of antigen molecules CD11b,CD14,CD33,CD34,CD38,CD117 and MPO in M₅ patients and the complete remission rate of induced remission therapy（P>0.05）.It could not be ruled out that the number of cases in each group was too small,and there was no difference in statistical analysis.6.The complete remission analysis of antigen molecule combination in patients with induced remission showed that the number of patients in the double positive plus double negative group（CD 33+CD34+CD11b-CD56-）in M₄ patients was lower than that in the non-double positive plus double negative group（P=0.05）,indicating that the expression of CD33+CD34+CD11b-CD56-in M₄ patients with leukemia predicted a poor prognosis.In M₅ type patients,the number of patients in the double positive group（CD33+CD34+）was lower than that in the non-double positive group,and the difference was statistically significant（P=0.04）.No statistical difference was found in other groups,indicating that the expression of CD33+CD34+in M₅ type leukemia patients predicted poor prognosis.Research conclusion:1.The prevalence of M₄ and M₅ leukemia in men is slightly higher than that in women,and the incidence rate increases with age.2.Blood routine examination showed that M₄ leukemia patients were more prone to thrombocytopenia than M₅ leukemia patients.M₄ and M₅ leukemias are prone to splenomegaly and active bone marrow hyperplasia.3.M₄ leukemia commonly expresses CD33 and CD38 antigen molecules.M₅leukemia commonly expresses CD38 and CD15 antigen molecules.The differential antigen molecules between M₄ and M₅ leukemia include CD11b,CD14,CD56,CD33,CD34,CD117 and MPO.4.The expression of double positive（CD33+CD34+）and double positive（CD33+CD34+）combined with double negative（CD11b-CD56-）tended to be M₄leukemia.The expression of CD11b+CD56+in the double positive group was more inclined to M₅ leukemia.5.The complete remission rate of M₄ and M₅ leukemia treated with induction remission therapy is basically the same.The positive expression of M₄ leukemia antigen molecule CD34 indicates that the remission rate of induction remission therapy is low and the prognosis of patients is poor.6.The expression of CD33+CD34+CD11b-CD56-in patients with M₄ leukemia indicates poor prognosis.The expression of CD33+CD34+in patients with M₅leukemia indicates a poor prognosis.