Saikevych I A, Kerrigan D P, McConnell T S, Head D R, Appelbaum F R, Willman C L
Department of Pathology, University of New Mexico School of Medicine, Albuquerque.
Leukemia. 1991 May;5(5):373-82.
Morphological, immunological, cytogenetic, and molecular features of 28 cases of acute mixed lineage leukemia (AMLL), defined by the co-expression of lymphoid and myeloid cell surface antigens, were correlated in a multiparameter study. These 28 cases were identified in a series of 260 consecutive acute leukemia cases occurring predominantly in adults and were subdivided into 18 cases of AMLL with myeloid morphology and cytochemistry (AMLL-AML) and 10 cases of AMLL with lymphoid morphology and cytochemistry (AMLL-ALL). A lack of correlation was observed between the expression of B- or T-cell associated antigens with the presence of the expected immunoglobulin (Ig) or T-cell receptor (TCR) gene rearrangements in the AMLL cases with myeloid morphology. Only three of the 18 total AMLL-AML cases, each co-expressing B- and myeloid-associated cell surface antigens (B/My), had Ig heavy chain gene rearrangements with or without rearrangements of TCR genes. Ig light chain genes remained in the germline configuration. Strikingly, these three cases were the only AMLL-AML cases in our series to have the Philadelphia (Ph) chromosome translocation t(9;22)(q34;q11), suggesting that a significant percentage of acute leukemias with myeloid morphology and gene rearrangements may be Ph+ AMLL. The fact that three of the 10 B/My AMLL-AML cases in our series were Ph+ suggests that there may be an increased frequency of Ph chromosome, a translocation associated with a poor prognostic outcome, in B/My AMLL-AML occurring in the adult population. Although most AMLL cases with lymphoid morphology had Ig and TCR gene rearrangements associated with a variety of immunophenotypes and karyotypes, two Ph+ AMLL-ALL cases had many similar features (B/My immunophenotype; IgH with or without TCR rearrangements; Ig light chain genes germline) to their Ph+ AMLL-AML counterparts. However, the Ph+ AMLL-ALL cases differed from the Ph+ AMLL-AML cases by the expression of a more mature B-cell lineage immunophenotype and by their additional cytogenetic changes.
在一项多参数研究中，对28例急性混合谱系白血病（AMLL）的形态学、免疫学、细胞遗传学和分子特征进行了相关性分析，这些病例通过淋巴样和髓样细胞表面抗原的共表达来定义。这28例病例是在一系列主要发生于成人的260例连续急性白血病病例中识别出来的，并被细分为18例具有髓样形态学和细胞化学特征的AMLL（AMLL-AML）以及10例具有淋巴样形态学和细胞化学特征的AMLL（AMLL-ALL）。在具有髓样形态学的AMLL病例中，观察到B细胞或T细胞相关抗原的表达与预期的免疫球蛋白（Ig）或T细胞受体（TCR）基因重排之间缺乏相关性。在总共18例AMLL-AML病例中，只有3例同时共表达B和髓样相关细胞表面抗原（B/My），它们有Ig重链基因重排，伴或不伴有TCR基因重排。Ig轻链基因保持种系构型。引人注目的是，这3例病例是我们系列中仅有的具有费城（Ph）染色体易位t(9;22)(q34;q11)的AMLL-AML病例，这表明相当比例的具有髓样形态学和基因重排的急性白血病可能是Ph+ AMLL。我们系列中10例B/My AMLL-AML病例中有3例是Ph+，这一事实表明，在成人中发生的B/My AMLL-AML中，与预后不良相关的Ph染色体易位的频率可能增加。尽管大多数具有淋巴样形态学的AMLL病例有与多种免疫表型和核型相关的Ig和TCR基因重排，但2例Ph+ AMLL-ALL病例与其Ph+ AMLL-AML对应病例有许多相似特征（B/My免疫表型；IgH伴或不伴TCR重排；Ig轻链基因种系）。然而，Ph+ AMLL-ALL病例与Ph+ AMLL-AML病例的不同之处在于表达更成熟的B细胞谱系免疫表型以及存在额外的细胞遗传学改变。
