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目的:探讨慢性髓细胞白血病急变期(CML-BC)患者的细胞形态学(M)、免疫学(I)、细胞遗传学(C)和分子生物学(M)的特征及应用价值。方法:对38例CML-BC患者的MICM分型进行回顾性分析。结果:以FAB分型为基础的形态学确诊率达94.7%;免疫分型结果为:38例CML-BC中CML-AML占71.0%,其中37.0%伴淋系表达;CML-ALL占23.7%,均为B细胞性,其中66.67%伴髓系表达;CML-MAL(混合性白血病)占5.3%,均为B系和髓系混合表达;CD34+26例(68.4%),CD7+10例(26.3%),均与CD34共表达。细胞遗传学结果显示:CML特征性Ph染色体检出率为94.3%(36/38),附加异常染色体检出率为60.5%(23/38),发生频率较高的类型是+Ph、+8和i(17q);FISH检测BCR/ABL融合基因阳性率为100%,der(9)缺失占14.7%。RT-PCR检测20例患者BCR/ABL融合基因均为阳性,其中b2a2型(12/20),b3a2型(8/20),1例(1/20),b2a2和b3a2双阳性(1/20)。结论:CML-BC是造血干细胞疾病,原始细胞分化阻滞在早期阶段,预后差。MICM分型对CML-BC的诊断、治疗和预后判断均有重要价值。
Objective: To investigate the characteristics and application of cytomorphology (M), immunology (I), cytogenetics (C) and molecular biology (M) in patients with chronic myeloid leukemia (CML) Methods: The MICM classification of 38 patients with CML-BC was retrospectively analyzed. RESULTS: The morphological diagnosis rate based on FAB typing was 94.7%. Immunohistochemical results showed that CML-AML accounted for 71.0% in 38 cases of CML-BC, of which 37.0% had lymph node metastasis and 23.7% (66.67%) with myeloid, CML-MAL (mixed leukemia) accounting for 5.3%, all of which were mixed with B and myeloid; CD34 + 26 (68.4%) and CD7 + (26.3%), all co-expressed with CD34. The results of cytogenetics showed that the prevalence of Ph chromosome in CML was 94.3% (36/38) and the rate of additional abnormal chromosome was 60.5% (23/38) And i (17q). The positive rate of BCR / ABL fusion gene detected by FISH was 100%, and the deletion of der (9) accounted for 14.7%. The BCR / ABL fusion gene was detected by RT-PCR in 20 patients, including b2a2 (12/20), b3a2 (8/20), 1 (1/20), b2a2 and b3a2 ). CONCLUSION: CML-BC is a hematopoietic stem cell disease with poor prognosis in the early stage of differentiation of primary cells. MICM classification of CML-BC diagnosis, treatment and prognosis have important value.