白血病期套细胞淋巴瘤免疫表型分析

摘要

套细胞淋巴瘤(MCL)是一种侵袭性成熟B细胞淋巴瘤,利用流式细胞仪和细胞遗传学等技术发现大部分MCL患者疾病诊断时已处于白血病期,在临床上容易误诊.本研究分析白血病期套细胞淋巴瘤的免疫表型.回顾性分析22例白血病期MCL患者的外周血流式免疫表型资料,所有患者采用原位荧光杂交技术证实均存在t(11；14)易位.流式细胞术分析了CD3、CD4、CD5、CD8、CD10、CD19、CD20、CD22、CD23、CD25、CD38、CD103、CD148、CD200、FMC7、ZAP-70、k、λ的表达.结果表明:所有患者CD5、CD19、CD20表达均阳性,且CD20表达较强；轻链为单克隆限制性表达；17例患者CD22弱阳性；6例患者CD23阳性,其中2例表达较强；12例患者FMC7阳性.按慢性淋巴细胞白血病免疫表型积分系统评分,5例患者积4分,其余17例患者积2-3分.本组检测了18例患者CD200、CD148抗原的表达,其中11例患者CD200表达阴性,7例患者CD200表达弱阳性,阳性患者流式细胞仪检测中位荧光强度(MFI)为25.8(6.6-254.26)；18例患者的CD148表达均阳性,中位MFI为337(73.4-1341.9).结论:白血病期MCL患者免疫表型常有不典型表达,MCL的诊断需要结合细胞形态学、免疫表型和细胞遗传学综合诊断；新型分子标记物CD200和CD148在MCL中具有较为特殊的表达模式,对慢性B淋巴细胞增殖性疾病具有较好的鉴别诊断价值.%Mantle cell lymphoma (MCL) is a kind of mature B-cell neoplasms with significantly poor prognosis and is usually misdiagnosed. With the development of flow cytometry and cytogenetic technique, most patients were at leukemic phase when diagnosed. This study was purposed to investigate the immunophenotypes of MCL, the immunophenotype information of 22 leukemic MCL patients was analyzed retrospectively. All the patients were conformed t(11;14) translocation by fluorescence in situ hybridization. Immunophenotypes were detected by a four-color flow cytometry including CD3,CD4,CD5,CD8,CD10,CD19,CD20,CD22,CD23,CD25,CD38, CD103,CD148, CD200,FMC7,ZAP-70,Κ,Λ. The results showed that CD19, CD5, CD20 and monoclonal slg expressed in all 22 patients with CD20 high expression; CD22 expressed weakly in 17 patients; CD23 expressed in 6 patients including 2 cases highly expressed; FMC7 expressed in 12 patients. 5 patients were 4-point score and 17 patients had a score less than 4 according to CLL scoring system. CD148 and CD200 were detected in 18 patients, in which CD200 expressed negatively in 11 patients, CD200 expressed weakly in 7 patients with median fluorescence intensity (MFI) 25. 8(6.6 -254.26); CD148 expressed positively in all 18 patients with median MFI: 337(73.4 -1341.9). It is concluded that the atypical immunophenotype is common in leukemia MCL, thereby the diagnosis of MCL needs comprehensively analyze with morphocytology, immunophenotype and cytogenetic, CD200 and CD148 as new bio-markers can differentiate MCL from chronic B cell lymphoproliferative disease.