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目的分析上海市急性白血病(AL)采用世界卫生组织(WHO)分型的基本情况,比较WHO 分型和 FAB 分型的优缺点。方法收集连续性样本,对上海市中美联合白血病协作组收治的572例 AL 患者同时采用 FAB 和 WHO 标准进行分型诊断。结果 572例 AL 中急性髓系白血病(AML)436例(76.2%),急性淋巴细胞白血病(ALL)119例(20.8%),急性全髓细胞白血病1例,急性混合细胞白血病5例,急性侵袭性 NK 细胞白血病9例,急性浆细胞白血病2例,AML 和 ALL 之比为3.66:1。再现性细胞遗传学异常 AML 占35.3%,AML 伴多系病态造血占13.1%,治疗相关性 AML占0.9%,不属于上述分类的 AML 占50.7%,治疗相关性 AML 比例低于国外报道。ALL 中 B-ALL 占84.9%。AML FAB 分型中 M_4型最多,占38.5%,M_3和 M_4亚型比例高于国外报道,M_1型比例低于国外报道。AML 染色体异常率为60.8%,AML 伴 t(15;17)比例高于国外报道,染色体预后良好者占30.6%,预后中等者占51.5%,预后不良者占17.9%。B-ALL 中 t(9;22)占33.7%。结论上海市成人 AML 的 WHO 分型和染色体异常类型与国外有显著不同。与上海市1984至1994年 AL 资料相比,AML 的亚型分布有所变化,M_4亚型比例增多,M_1和 M_5亚型比例减少。
Objective To analyze the basic situation of WHO classification of acute leukemia (AL) in Shanghai and compare the advantages and disadvantages of WHO classification and FAB classification. Methods A total of 572 cases of AL patients who were treated in the Shanghai-US Joint Leukemia Cooperative Group were enrolled in this study. The FAB and WHO criteria were used to diagnose the patients. Results A total of 572 acute myeloid leukemia (AML) cases were found in 436 cases (76.2%), acute lymphoblastic leukemia (ALL) in 119 cases (20.8%), acute myeloid leukemia in 1 case, acute mixed leukemia in 5 cases, acute invasion 9 cases of NK cell leukemia, 2 cases of acute myeloid leukemia, AML and ALL ratio of 3.66: 1. Reproductive cytogenetic abnormalities AML accounted for 35.3%, AML with multiple lineage morbid hematopoietic accounted for 13.1%, treatment-related AML accounted for 0.9%, AML did not belong to the above categories accounted for 50.7%, the proportion of treatment-related AML lower than reported abroad. ALL in B-ALL accounted for 84.9%. AML FAB genotype M_4 type the most, accounting for 38.5%, M_3 and M_4 subtype is higher than the foreign reports, M_1 type lower than the foreign reports. AML chromosomal aberration rate was 60.8%, AML with t (15; 17) ratio higher than those reported abroad, the good prognosis of chromosomes accounted for 30.6%, the prognosis was 51.5%, and the poor prognosis was 17.9%. Among B-ALL, t (9; 22) accounted for 33.7%. Conclusion The WHO type and chromosomal abnormalities in adult AML in Shanghai are significantly different from those in other countries. Compared with AL data from 1984 to 1994 in Shanghai, the subtype distribution of AML changed, the proportion of M_4 subtype increased, and the proportion of M_1 and M_5 subtype decreased.