Ishii E, Okamura J, Tsuchida M, Kobayashi M, Akiyama Y, Nakahata T, Kojima S, Hanada R, Horibe K, Sato T
Department of Pediatrics, Kyushu University, Fukuoka, Japan.
Med Pediatr Oncol. 1991;19(1):28-32. doi: 10.1002/mpo.2950190106.
Forty-eight Japanese infants with acute lymphoid leukemia (ALL) (n = 24) and acute nonlymphoid leukemia (ANLL) (n = 24) were analyzed on the basis of clinical and laboratory data. Morphologically, 20 of the 24 infants with ALL were of the FAB L1 type, and 20 of the 24 infants with ANLL were of the M4 or M5 type. Markedly enlarged liver and spleen, and hyperleukocytosis (more than 50,000/microliters) were seen in 9, 12, and 14 infants with ALL and 10, 11, and 10 infants with ANLL, respectively. Initial CNS leukemia was evident in 2 infants. Chromosome studies of the leukemic cells showed abnormal karyotypes in 9 of the 21 infants with ALL and 19 of the 22 infants with ANLL, consisting mainly of translocation 11, 12, and inversion 16. By surface marker analysis, only 7 of the 22 infants with ALL (32%) were diagnosed as having common ALL (HLA-DR+, CD19+, CD10+). Of the 15 infants with ANLL, 12 and 5 infants also showed reactivity to HLA-DR and CD19, respectively. All of the 5 ANLL infants with lymphoid markers showed different leukemic cell features at the time of relapse. Twelve of the 19 infants with ALL (63%) who achieved a complete remission relapsed within the first 2 years; 8 of the 21 with ANLL (38%) relapsed within the first year. Analysis of event-free survival shows that the ALL infants with hyperleukocytosis have a poorer prognosis than those without hyperleukocytosis (p less than 0.05). Infant leukemia originates in a multipotent cell with lymphoid and myeloid features, and intensive multiagent chemotherapy is necessary for the treatment of infants with acute leukemia.
基于临床和实验室数据，对48名患有急性淋巴细胞白血病（ALL）（n = 24）和急性非淋巴细胞白血病（ANLL）（n = 24）的日本婴儿进行了分析。形态学上，24名ALL婴儿中有20名属于FAB L1型，24名ANLL婴儿中有20名属于M4或M5型。ALL组分别有9名、12名和14名婴儿，ANLL组分别有10名、11名和10名婴儿出现明显的肝脾肿大和白细胞增多（超过50,000/微升）。2名婴儿出现初始中枢神经系统白血病。白血病细胞的染色体研究显示，21名ALL婴儿中有9名以及22名ANLL婴儿中有19名核型异常，主要包括11号、12号染色体易位和16号染色体倒位。通过表面标志物分析，22名ALL婴儿中只有7名（32%）被诊断为普通ALL（HLA-DR +、CD19 +、CD10 +）。15名ANLL婴儿中，分别有12名和5名婴儿也对HLA-DR和CD19有反应。5名具有淋巴标志物的ANLL婴儿在复发时均表现出不同的白血病细胞特征。19名ALL婴儿中有12名（63%）在头2年内达到完全缓解后复发；21名ANLL婴儿中有8名（38%）在第一年内复发。无事件生存分析表明，白细胞增多的ALL婴儿预后比无白细胞增多的婴儿差（p < 0.05）。婴儿白血病起源于具有淋巴和髓系特征的多能细胞，强化多药化疗对于治疗急性白血病婴儿是必要的。
