Ding Bingjie, Zhou Lanlan, Jiang Xuejie, Li Xiaodong, Zhong Qingxiu, Wang Zhixiang, Yi Zhengshan, Zheng Zhongxin, Yin Changxin, Cao Rui, Liao Libin, Meng Fanyi
Hematology Department, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China.
Hematology Department, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China ; Hematology Department, Kanghua Hospital, Dongguan 523080, China.
Dis Markers. 2015;2015:382186. doi: 10.1155/2015/382186. Epub 2015 Apr 7.
Mixed phenotype acute leukemia (MPAL) is a complex entity expressing both lymphoid and myeloid immunophenotyping. In the present study, 47 MPAL, 60 lymphoid antigen-positive acute myeloid leukemia (Ly(+)AML), and 90 acute myeloid leukemia with common myeloid immunophenotype (Ly(-)AML) patients were investigated. We found that, in MPAL patients, there were high proportions of blast cells in bone marrow and incidence of hepatosplenomegaly, lymphadenopathy, and Philadelphia chromosome. The overall survival (OS) and relapse-free survival (RFS) in MPAL patients were significantly shorter than those in Ly(+)AML and Ly(-)AML. With regard to the patients with normal karyotype only, the OS and RFS of MPAL were significantly lower than those of the Ly(+)AML and Ly(-)AML; but there were no significant differences in OS and RFS among the patients with complex karyotype. The OS rates of 3 groups with complex karyotype were lower than those of patients with normal karyotype. In Cox multivariate analysis, complex karyotype was an independent pejorative factor for both OS and RFS. Therefore, MPAL is confirmed to be a poor-risk disease while Ly(+)AML does not impact prognosis. Complex karyotype is an unfavorable prognosis factor in AML patients with different immunophenotype. Mixed immunophenotype and complex karyotype increase the adverse risk when they coexist.
混合表型急性白血病（MPAL）是一种表达淋巴样和髓样免疫表型的复杂实体。在本研究中，对47例MPAL、60例淋巴样抗原阳性急性髓系白血病（Ly(+)AML）和90例具有常见髓系免疫表型的急性髓系白血病（Ly(-)AML）患者进行了调查。我们发现，MPAL患者骨髓中原始细胞比例高，肝脾肿大、淋巴结病和费城染色体的发生率高。MPAL患者的总生存期（OS）和无复发生存期（RFS）明显短于Ly(+)AML和Ly(-)AML患者。仅就核型正常的患者而言，MPAL的OS和RFS明显低于Ly(+)AML和Ly(-)AML；但复杂核型患者的OS和RFS之间无显著差异。3组复杂核型患者的OS率低于核型正常的患者。在Cox多因素分析中，复杂核型是OS和RFS的独立不良因素。因此，证实MPAL是一种高危疾病，而Ly(+)AML不影响预后。复杂核型是不同免疫表型AML患者的不良预后因素。混合免疫表型和复杂核型共存时会增加不良风险。
