| Objective: Analysis of the change of biological markers in patients withacute myeloid leukemia (AML) before and after relapse In order to improvethe response rate of relapsd AML.Methods:（1）The specimens were selected from the Second Hospital ofHebei Medical University, Department of Hematology, March2007toDecember2011diagnosed for AML patients which acquired completeremission and then relapsed of60patients, aged from14years old to75yearsold (median age37years).（2）The biological indicators were analyzed inthose patients,to search the difference between new diagnosed patients andrelapsed patients.(3) the results were analyzed by SPSS16.0,data presented as±S（immunophenotyping presented as percentiles）, using Wilcoxon test topairwise comparison. the correlation between the percentage of blast cells inthe bone marrow and serum enzymes by Pearson correlation analysis. α=0.05was a significant level of testing.Results:1The change of the blood white blood cells was statistically significant (P<0.05) before and after relapse, at diagnosis （8.89±5.34）×10~9/L,after relapse （13.7±5.92）×10~9/L, respectively.2The change of immunophenotyping before and after recurrence, Myeloidantigen（MPO、CD13、CD33、CD15、CD117、CD64） expression ratewasno significant difference before and after the recurrence（P>0.05）;Lymphoid antigens in some changes before and after the recurrence, theexpression of CD7first visit to relapse from positive to negative were2cases, from negative to positive were6cases，persistently positive inthree cases, before and after recurrence the difference of the expressionrate of CD7was not statistically significant; the expression of CD11b first visit to relapse from positive to negative was1cases of patients, fromnegative to positive were5cases, continuous positive were3cases, beforeand after recurrence the difference of the expression rate of CD11b wasnot statistically significant; CyCD3in newly diagnosed20casesexpression were0, the expression rate of two cases of recurrence were96.42%and17.89%; No expression in the CD10first visit, the expressionrate were24.50%of M5patients after relapse; CD19when newlydiagnosed only three cases of (2cases of the M4and M5cases) there isweak expression of <20%and in recurrence cases only one case with M4express, the expression rate was68.65%，no expression of other lymphoidantigen were found in patients before and after relapsed; in newlydiagnosed patients, the expression rate of CD56were P250%，P502.5%，P7521%, when recurrent the expression rate were P2515.25%, P5034.5%,P7583.5%, before and after recurrence the difference of the expressionrate was statistically significant (P <0.05), before and after recurrence theexpression from negative to positive were7cases,2cases were frompositive to negative; The expression of HLA-DR at diagnosis were P255%,P5062%, P7585%, after relapse the expression rate was P2515.25%, P5034.5%, P7583.5%, before and after recurrence the difference of theexpression rate were no statistically significant (P <0.05), and before andafter recurrence its expression from negative to positive were3cases,from positive to negative were7cases; the expression of CD34atdiagnosis were P251%, P5018.5%, P7579%, after recurrence theexpression rate were P252.25%, P5039%, P7578.75%, before and afterrelapsed the difference of expression rate were no statistically significant(P <0.05), before and after relapse its expression from negative to positivewere4cases from positive to negative were3cases.3The change of molecular biology Studied60cases of AML patientsbefore and after the recurrence,35cases of patients with M2, theAML1/ETO fusion gene were detected11cases in newly diagnosedpatients, after recurrence were9cases, which changed from positive to negative were5cases, from negative to positive were3cases.3of4casesof APL patients with newly diagnosed, PML/RARα fusion gene werepositive, all4patients were positive after relapse;3of8cases of M4patients, initial expression CBFβ/MYH11, from positive to negative in2cases after recurrence,1cases from negative to positive.4The change of serum enzymes, electrolytes, glucose before and afterrecurrence Before and after recurrence the blood sugar, serumelectrolytes(serum potassium, sodium) were not significant difference (P>0.05); the changes of Serum enzyme, the comparison of recurrence ofserum lactate dehydrogenase, LDH level, before relapse was (281.5±104.21) u/L,20cases were higher than the upper limit of normal cases,after recurrence (453.20±103.37) U/L,29cases were higher than theupper limit of normal, the difference of LDH level was statisticallysignificant P <0.05before and after the recurrence; before and afterrecurrence, the comparison of the serum alkaline phosphatase(ALP),before relapse was (61.15±26.26) u/L,1case which was higher thanthe upper limit of normal cases; after relapse was (65.98±19.74) u/L,all patients ALP were within normal range. before and after relapse thecomparison of ALP levels were not significant differences (P>0.05);before and after recurrence the comparison of the levels of GGT, beforerelapse, the levels of GGT higher than normal level of patients were6cases (10%), after relapse, higher than normal level were15cases (25%),before relapse was (37.07±8.13) u/L; after recurrence was (48.3±9.08)u/L, before and after recurrence the comparison of GGT levels weresignificant differences(P＜0.01). before and after relapse the Serum LDHlevels and the proportion of primitive cells in the bone marrow into apositive correlation (first visit r=0.716, P <0.05; recurrence r=0.379, P<0.05), but had no correlation with the WBC count. GGT levels and bonemarrow, the proportion of primitive cells and peripheral blood white bloodcell count was not correlation. Conclusion:1The white blood count of60cases of AML patients have obviousdifference before and afte recurrence, after recurrence white blood countwas obviously rises.2The immune phenotype of AMLpatients, The rate of myeloid antigenexpression are not significant difference before and after the recurrence;before and after the recurrence some caes have lymphoid antigenexpression, Just with the change of the type of antigen and the expressionrate;the expression rate of CD56is significant difference before and afterthe relapse; before and after relapse the expression of HLA-DR, CD34rateof are not significant difference.3The change of molecular biology, AML1/ETO fusion gene in AML-M2patients, AML-M3patients with PML/RARα fusion gene, AML-M4patients with CBFβ/MYH11fusion gene, the expression of them in thenumber of positive cases has changed.4The changes of blood glucose, serum electrolytes, serum enzyme, beforeand after recurrence the level of glucose than the normal value increased tovarying degrees, but before and after relapse the difference are notstatistically significant; before and after recurrence the serum electrolytes(serum potassium, serum sodium) have no significant difference; beforeand after recurrence, the difference of the levels of serum LDH isstatistically significant, the level is significantly increased after recurrence,and is positively correlated with the proportion of primitive cells in thebone marrow; before and after relapse the Serum GGT level is statisticallysignificant differences in relapse, the level is significantly increased;before and after the recurrence there is no significant difference. |
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