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[50例骨髓增生异常综合征患者细胞遗传学异常的荧光原位杂交检测及传统核型分析]

[Cytogenetic abnormalities of 50 MDS patients by FISH detection and conventional karyotype analysis].

作者信息

Gao Dong-Ge, Li Bo-Tao, Zhou Li-Na, Chen Hu, Zhang Bin

机构信息

Department of Hematopoietic Stem Cell Transplantation, Hospital Affiliated to Academy of Military Medical Sciences, The Chinese PLA Institute of Hematopoietic Stem Cell, Beijing 100071, China.

出版信息

Zhongguo Shi Yan Xue Ye Xue Za Zhi. 2013 Oct;21(5):1190-4. doi: 10.7534/j.issn.1009-2137.2013.05.021.

Abstract

This study was purposed to compare detectable rate of cytogenetic abnormalities including -5/5q-, -7/7q-, 20q-,+8, and -Y in MDS by FISH and metaphase cytogenetics, and to investigate the relationship between cytogenetic abnormalities and progression from MDS to acute leukemia. Metaphase cytogenetics and FISH testing for -5/5q-, -7/7q-, 20q-,+8, and -Y were performed in 50 bone marrow samples obtained from patients with MDS diagnosed according to the WHO criteria (2008). Evolution from MDS to AML was followed up for each patient. The results showed that the cytogenetic abnormalities including -5/5q-, -7/7q-, 20q-,+8, and -Y were identified in 25 (50%) of 50 by metaphase cytogenetics, and in 20 (40%) of 50 by FISH. -5/5q-, 7/7q-, 20q- , +8, or -Y was identified by metaphase cytogenetics in 3 (6%) of 50, 13 (26%) of 50, 6 (12%) of 50, 12 (24%) of 50, and 1 (2%) of 50, respectively, and by FISH in 3 (6%) of 50, 10 (20%) 0f 50, 3 (6%) of 50, 10 (20%) of 50, and 1 of 50 (2%), respectively. The detectable rate ranking was -7/7q- >+8>20q->-5/5q->-Y. 47 patients received allogeneic hematopoietic stem cell transplantation. In the IPSS poor prognosis group, 6 (46.2%)of 13 received transplantation before progression to acute leukemia. In the IPSS good prognosis group, 10 (45.5% ) of 22 received transplantation before progression to acute leukemia. In the IPSS intermediate prognosis group, 2 (16.7%) of 12 received trans- plantation before progression to acute leukemia. The rate of progression to acute leukemia was 7.7% (1/13) in the IPSS poor prognosis group, 4.5% (1/22) in the IPSS good prognosis group, and 58.3% (7/12) in the IPSS intermediate prognosis group. The low rate of progression to acute leukemia in the IPSS poor prognosis group might be associated with the high rate of allogeneic hematopoietic stem transplantation. It is concluded that there is higher detectable rate for detecting a certain chromosome by FISH probe than that by metaphase cytogenetics, especially for detecting low clone chromosomal abnormalities and mitotic figures less than 20. There is no difference between IPSS good prognosis group and IPSS poor prognosis group in our study probably because of allogeneic hematopoietic stem cell transplantation.

摘要

本研究旨在比较荧光原位杂交(FISH)技术与中期细胞遗传学技术检测骨髓增生异常综合征(MDS)中细胞遗传学异常(包括-5/5q-、-7/7q-、20q-、+8及-Y)的检出率,并探讨细胞遗传学异常与MDS向急性白血病进展之间的关系。对50例根据世界卫生组织(WHO,2008年)标准诊断为MDS的患者的骨髓样本进行中期细胞遗传学分析以及针对-5/5q-、-7/7q-、20q-、+8及-Y的FISH检测。对每位患者随访MDS向急性髓系白血病(AML)的进展情况。结果显示,中期细胞遗传学技术在50例患者中检测到25例(50%)存在-5/5q-、-7/7q-、20q-、+8及-Y等细胞遗传学异常,FISH技术检测到20例(40%)存在上述异常。中期细胞遗传学技术检测到-5/5q-、7/7q-、20q-、+8及-Y的比例分别为50例中的3例(6%)、13例(26%)、6例(12%)、12例(24%)及1例(2%),FISH技术检测到上述异常的比例分别为50例中的3例(6%)、10例(20%)、3例(6%)、10例(20%)及1例(2%)。可检出率排序为-7/7q->+8>20q->-5/5q->-Y。47例患者接受了异基因造血干细胞移植。在国际预后积分系统(IPSS)预后不良组中,13例患者中有6例(46.2%)在进展为急性白血病之前接受了移植。在IPSS预后良好组中,22例患者中有10例(45.5%)在进展为急性白血病之前接受了移植。在IPSS预后中等组中,12例患者中有2例(16.7%)在进展为急性白血病之前接受了移植。IPSS预后不良组进展为急性白血病的发生率为7.7%(1/13),IPSS预后良好组为4.5%(1/22),IPSS预后中等组为58.3%(7/12)。IPSS预后不良组进展为急性白血病的发生率较低可能与异基因造血干细胞移植率较高有关。结论是,FISH探针检测特定染色体的检出率高于中期细胞遗传学技术,尤其对于检测低克隆染色体异常及有丝分裂相少于20的情况。在本研究中,IPSS预后良好组与IPSS预后不良组之间无差异,可能是由于异基因造血干细胞移植的原因。

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