摘要
目的探讨儿童急性早幼粒细胞白血病(APL)治疗后转为急性单核细胞白血病(AML-M5)的细胞遗传学和分子遗传学机制。方法对1例急性早幼粒细胞白血病患儿的诊断、连续缓解和复发的整个过程应用细胞形态学、组织化学、细胞遗传学和分子遗传学方法进行监测。结果该患儿经骨髓细胞形态学、染色体以及融合基因检查确诊为APL,缓解期间PML/RARα融合基因始终阳性;完全缓解30个月后复发,而此时染色体恢复正常、PML/RARα融合基因转阴;细胞和分子遗传学检查示转型为AML-M5,转型后经再诱导治疗无效死亡。结论急性早幼粒细胞白血病治疗后转为急性单核细胞白血病为特殊复发形式,耐药性强,治疗效果差。其原因可能与白血病次级克隆扩增或药物诱导的克隆改变有关。
Objective To observe cytogenetic and molecular genetic mechanism of acute promyelocytic leukemia （APL） switching to acute monocytic leukemia （AML - MS）. Methods Conventional morphologic, cytochemical, cytogenetic and molecular genetic studies were used to detect the whole process of diagnosis and subsequent remission and relapse in one case of APL. Results This child was diagnosed as APL through the examination of blast cell morphology, chromosome and blending gene. The blending gene of PML/RARα was positive during the complete remission. The child relapsed after 30 months of complete remission. The blending gene of PML/RARα became negative. AML - M5 was showed after the genetic examination of ceil and molecule. After lineage switch, reinduction was used but the treatment was not effective, the child died. Conclusion A- cute promyelocytic leukemia switching to acute monocytic leukemia is a special relapse form, which has a strong drug tolerance and poor curative effect. The cause might be related to the expansion of a secondary clone or the drug - induced clone change.
出处
《中国全科医学》
CAS
CSCD
2006年第16期1376-1377,共2页
Chinese General Practice
关键词
白血病
早幼粒细胞
急性
白血病
单核细胞
急性
转型
儿童
Leukemia, promyelocytic, acute
Leukemia, monocytic, acute
Lineage conversion
Children
