Pui C H, Williams D L, Kalwinsky D K, Look A T, Melvin S L, Dodge R K, Rivera G, Murphy S B, Dahl G V
Blood. 1986 Jun;67(6):1688-92.
Leukemic cells from 89 (24%) of 369 children with newly diagnosed acute lymphoblastic leukemia (ALL) were found to have a pre-B immunophenotype. By comparison with blasts having the common ALL phenotype, the pre-B cells were more likely to have a DNA index less than 1.16 (P = 0.02), a pseudodiploid karyotype (P less than 0.001), and a chromosomal translocation (P = 0.001). Increased serum lactic dehydrogenase levels (P = 0.001) were also characteristic of pre-B ALL; otherwise, the clinical and laboratory features of the two groups were similar. A nonrandom chromosomal translocation, t(1;19)(q23;p13.3), was identified in blast cells from 16 (23%) of the 70 patients with pre-B ALL and adequate chromosome banding studies; different translocations were found in 11 of the remaining patients. The presence of any chromosomal translocation in the pre-B group was significantly related to a higher leukocyte count, an increased level of serum lactic dehydrogenase, an increased percentage of S-phase cells, black race, and a blast cell DNA index less than 1.16. Four presenting features were found to confer an increased risk of treatment failure among pre-B patients: pseudodiploidy, chromosomal translocation, black race, and higher serum lactic dehydrogenase level. In a multivariate analysis, pseudodiploidy emerged as the strongest factor for predicting relapse in pre-B ALL. The frequent association of chromosomal abnormalities of known adverse prognostic significance and high serum lactic dehydrogenase levels with pre-B-cell ALL explains, at least in part, the poor treatment outcome reported for children with this subtype of leukemia.
在369例新诊断的急性淋巴细胞白血病（ALL）患儿中，89例（24%）的白血病细胞具有前B免疫表型。与具有常见ALL表型的原始细胞相比，前B细胞更有可能具有小于1.16的DNA指数（P = 0.02）、假二倍体核型（P < 0.001）和染色体易位（P = 0.001）。血清乳酸脱氢酶水平升高（P = 0.001）也是前B-ALL的特征；否则，两组的临床和实验室特征相似。在70例具有前B-ALL且有足够染色体带型分析的患者中，16例（23%）的原始细胞中鉴定出一种非随机染色体易位t(1;19)(q23;p13.3)；其余患者中有11例发现了不同的易位。前B组中任何染色体易位的存在与白细胞计数较高、血清乳酸脱氢酶水平升高、S期细胞百分比增加、黑人种族以及原始细胞DNA指数小于1.16显著相关。发现有四个呈现特征会使前B患者治疗失败的风险增加：假二倍体、染色体易位、黑人种族和较高的血清乳酸脱氢酶水平。在多变量分析中，假二倍体成为预测前B-ALL复发的最强因素。已知具有不良预后意义的染色体异常和高血清乳酸脱氢酶水平与前B细胞ALL的频繁关联至少部分解释了该亚型白血病患儿报告的治疗效果不佳的原因。
