精品干髓系免疫表型对儿童急性t淋巴细胞白血病的预后影响课件

干/髓系免疫表型对儿童急性T-淋巴细胞 白血病的预后影响 刘秋霞 上海儿童医学中心 血液肿瘤科 背 景 T-ALL较B-ALL预后差； 新造血系统模式：早期T系祖细胞（ETP)具有向髓系发育 的能力； 儿童T-ALL少部分病例免疫表型及基因表达谱和ETP极为 相似，文献提示他们预后极差. Nature，2009，V452 ETP CD1a cCD3 CD8 CD5 CD34 CD33 CD117 CD1a阴性、CD5弱 阳性、CD8阴性 CD13、CD33、 CD34、CD117、 HLA-DR 至少一种阳 性。 St Jude Childrens Research Hospital 材料和方法 2002-1至2008-12，上海儿童医学中心收诊的57例T- ALL(46)、双克隆-ALL(1)和NHL伴骨髓转移(10)初发病例 ； 回顾性分析初诊时免疫筛查CD13、CD33、CD34、 CD117、HLA-DR的表达，分为干/髓系表达组 (T/My+ALL)和无干/髓系表达组(T/My-ALL) 分类性别 年龄（1 岁、1且 10岁、 10岁） 外周血白 细胞计数 （*109/L ） 染色 体异 常 危险 度分 级 FAB 分型 纵膈肿 大 脏器浸 润 P 值 0.262 0.551 0.077 0.944 0.596 0.895 0.886 0.682 干/髓系抗原的表达与T-ALL的临床特征及形态学、遗传学的关系 结 果 1 T/My+ALL (31,54.6%), T/My-ALL (26,45.4%） 组别泼尼松诱导试 验 19天骨髓象D35缓 解 D35后延迟缓解 PGR PPRM1M2M3 T/My+ALL （N=31） 141116781810 T/My-ALL （N=26） 1292411 241 P值 0.9380.0020.006 T/My+ALL 与T/My-ALL早期疗效反应比较 结 果 2 组别 CR例数 诱导失败 复发 合并症死 亡 失访 5年EFS T/My+AL L（N=31 ） 28（ 90.3%） 3 8（ 25.8%） 2035.4% T/My-ALL （N=26） 25（ 96.2%） 1 6（ 23.1%） 1365.7% 总计 (N=57) 53 4 143352.5% P值 0.617 0.8120.209 T/My+ALL 与T/My-ALL长期疗效比较 结 果 3 结 论 T-ALL/NHL伴有干/髓系表面抗原表达时预后差，但未达 到统计学有效意义； T-ALL/NHL伴有干/髓系表面抗原表达不能替代ETP免疫 表型，目前尚不能将之作为儿童T系淋巴细胞白血病的预 后因素. 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