Guzzini F, Angelopoulos N, Banfi L, Coppetti D, Ceppi M, Camerone G
Divisione di Medicina II, Ospedale di Saronno, Varese.
G Clin Med. 1990 Mar;71(3):195-201.
In the last years, the development of immunophenotypic and molecular analyses allowed to recognize several cases of hybrid acute leukemia (AL), whose blast cell display both lymphoid and myeloid features. Hybrid, or mixed-lineage, AL seems to have distinct clinical manifestations and hematological findings, and is mainly characterized by resistance to chemotherapy and poor prognosis. We report on a patient with AL, which showed a very rapid switch from the lymphoblastic phenotype exhibited at presentation to a myelomonoblastic one, appeared at first relapse, and lastly progressed to an undifferentiated leukemia in the terminal phase. Together with this morphologic and cytochemical evolution, leukemic cells expressed, besides the primary early-B antigens, new immunological markers related to T-lymphocytic and myeloid lineages. Based on this observation and current understanding of the ontogenesis of hematologic malignancies, we discuss biological mechanisms which are likely to underlie hybrid leukemia.
在过去几年中，免疫表型和分子分析技术的发展使得人们能够识别出几例混合性急性白血病（AL），其原始细胞同时具有淋巴样和髓样特征。混合性或双系急性白血病似乎具有独特的临床表现和血液学特征，主要表现为对化疗耐药且预后不良。我们报告了一例急性白血病患者，该患者在初诊时表现为淋巴细胞表型，但在首次复发时迅速转变为髓单核细胞表型，最终在终末期进展为未分化白血病。伴随着这种形态学和细胞化学演变，白血病细胞除了表达主要的早期B抗原外，还表达了与T淋巴细胞和髓系相关的新免疫标志物。基于这一观察结果以及对血液系统恶性肿瘤发生机制的当前认识，我们讨论了混合性白血病可能的生物学机制。
