急性髓细胞白血病伴有CD16+/CD56+的临床特征及预后分析

摘要

目的：探讨急性髓细胞白血病（Acute myeloid leukemia，AML）伴有CD16+/CD56+的临床特征、LDH的变化、免疫学表型及染色体核型特征及预后。方法：2009年1月至2011年6月在我院确诊的119例非M3型AML患者，进行了细胞形态学、免疫细胞学、染色体，及基因学的检查。对诊断为急性髓性白血病伴有CD16+/CD56+的38例患者，分析了临床特征、LDH的变化，染色体核型表达、诱导缓解率及对其预后进行了评判，并与AMLCD56－CD16－进行了比较。结果：38例AMLCD16+/CD56+多分布于M2、M5，分别占55.26%、23.68%。M6中未见到CD16、CD56抗原表达。22例AMLCD56+/CD16＋伴有肝/脾/淋巴结肿大，30例AMLCD56－CD16－伴肝/脾/淋巴结肿大。AMLCD16+/CD56+LDH均值为956.68±842.75，AMLCD56－CD16－LDH均值为498.83±455.77，有统计学差异。AMLCD56+/CD16+中有22例出现了核型异常，主要为t（8,21）、＋4、＋8、＋21；23例AMLCD56－CD16－存在核型异常。两组化疗缓解率分别为44.7％、73％，存在明显差别。且AMLCD56+/CD16+缓解时间短，生存期短，与CD56－CD16－AML相比较，P值分别为0.032、0.047，有统计学差异。结论：AMLCD56+/CD16+多伴有肝/脾/淋巴结肿大、LDH水平升高、染色体核型异常较常见，缓解率较低，复发率较高，预后较AMLCD56-CD16-差。在巩固治疗中给予大剂量的化疗和尽早行异基因造血干细胞移植，以提高临床治愈率。%Objective:To explore the expression of CD56/CD16 in acute myloid leukemia and its significance in clinical features, LDH changes, immunological phenotype, karyotype features and prognosis.Methods:We retrospectively collected data of morphology , immunophenotype, karyotype and genetics from 119 cases of de novo non-M3 AML studied from January 2009 to June 2011.38 cases were CD56/CD16 positive, we analysised the clinical features, LDH changes,karyotype, remission rate and prognosis, compared with AMLCD56-CD16-. Results:The highest incidence of CD56/CD16 positivity was in FAB subtypes M2 and M5,55.26%(21/38) and 23.68%(9/38), respectively. The expression of CD56/CD16 was not seen in M6. In 38 cases AMLCD56+/CD16+,22 cases were with hepatomegaly/splenomegaly/ lymphadenectasis, comparing with 30 cases in 81 cases AMLCD56-CD16-. It showed a statistically significant difference of the LDH's mean value between AMLCD16+/CD56+and AMLCD56-CD16-(956.68 ± 842.75 vs 498.83 ± 455.77). 22 of 38 cases AMLCD56 +/CD16 + tested showed with karyotype abnormalities, mainly t (8,21),+4,+8,+21.23 of 81 cases AMLCD56-CD16- tested showed with karyotype abnormalities. CD56 expression was significantly associated with a reduced probability of achieving complete remission (CR) (44.7%vs73%) (P = 0.003) , a shorter remission time (4.5vs13 months) (P=0.032) as well as with a shorter survival(10.2vs18.5 months)(P =0.047).Conclusion:CD56/CD16 expression was significantly associated with a higher incidence of hepatomegaly/splenomegaly/lymphadenectasis, a higher level LDH,a higher incidence of karyotype abnormalities, a reduced probability of achieving complete remission(CR),a higher ralapse rate, a shorter remission time as well as with a shorter survival comparing with AMLCD56-CD16-.We can give large doses of chemotherapy in the consolidation treatment and make early allogeneic hematopoietic stem cell transplantation to improve the prognosis.