| Purpose:Analyze the clinical, biological features, treatment outcome and prognosis of mixed-lineage acute leukemia (MAL).Method:1. acute leukemia patients, from Jan.2001 to Mar.2006 in Wuhan Union Hospital, were selected. 48 patients of MAL were selected as investigation objective, including 34 male and 14 female, from 6-60 years old. During these cases, 5 cases of M1, 8 cases of M2, 1 case of M4, 1 case of M5, 6 cases of L1, 26 cases of L2, 1 case of L3 were including by French-American-British (FAB) classification. 48 MAL patients diagnosed according to European Group of International Leukemia (EGIL) scoring system were retrospectively analyzed and the analysis results were compared with that from 68 cases of AML and 61 cases of ALL. In AML group, 12 cases of M1,32 cases of M2, 9 cases of M3, 4 cases of M4, 11 cases of M5 were including as well as 10 cases of L1,45 cases of L2,6 cases of L3 in ALL group.2. All the patients were received bone marrow aspiration cytology, immunohistochemistry,immunophenotype, and some patients were received cytogenetic examination.3. Some clinical data were reviewed, including peripheral WBC count, Hemoglobin count, PLT count and their Median count; the incidences of enlargement of liver, spleen and lymphonodes; results of immunophenotype, and results of cytogenetics. In all treated patients, chemotherapy method, duration time for bone marrow suppression after chemotherapy and complete remission (CR) rate after chemotherapy were recorded. The differences of parameters in MAL and AML,ALL groups were compared so as to know the clinical characteristics, biological features, treatment outcome and prognosis of MAL.Results: 1. The incidence of MAL in acute leukemia was 9.6%. Morphologically, the subtypes of M1(10.4%) and M2(16.6%) were predominant in AML, as L2 (54.2%)in ALL.2. The median of white blood cell count in MAL was 40.2G/L, significantly higher than that of non-mixed-lineage cases (AML and ALL) observed during the same period (P<0.05). The incidences of enlargement of liver, spleen and lymphonodes in MAL were 39/48(81.25%) higher than those in AML,which were 32/68(47.1%). The difference was significant (P<0.01) and was not significant compared with those in ALL (P>0.05),which were 46/61(75.4%).3. The coexpression of myeloid and B lymphoid associated antigens was predominant, observed in 70.9% of MAL patients. The percentage for T lymphoid and myeloid antigens was 20.8%, for B, T lymphoid and myeloid antigens 8.3%.4. CD34 was expressed in 79.2% of the MAL cases respectively higher than those expressed in AML (54.4%) and ALL (52.5%), the difference was significant (P<0.01).5. Cytogenetic analysis revealed normal and abnormal karyotypes in 32.1% and 67.9% of the MAL cases. In MAL Ph chromosome abnormality incidence was 25% and was significantly higher than that in AML group (0%) (P<0.01) , but was not statistical difference with that in ALL (16.7%) (P>0.05).6. The completed remission rate of MAL was 38.1%, lower than CR rate in AML (70.8%) and ALL (72.2%) respectively (P<0.01). Treatment outcomes were negatively related to the expression of CD34 antigen and Ph chromosome.Conclusion: The following differences were existed compared with AML and ALL:1. Some clinical features of MAL were similar to ALL, manifesting strong extra- medullary infiltration and proliferation, like swelling of liver, spleen and (or) lymphonodes2. Coexpression of lymphoid/myeloid antigens was the major feature of MAL. CD34 was higher expressed in MAL than those expressed in AML and ALL. These concluded that MAL was supposed to be originated from stem cells.3. MAL was an uncommon leukemia which revealed a higher rate of abnormal karyotypes in cytogenetic analysis. 4. MAL had a lower CR rate and poor prognosis. Appropriate chemotherapeutic strategy should be further searched.
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