Williams D L, Tsiatis A, Brodeur G M, Look A T, Melvin S L, Bowman W P, Kalwinsky D K, Rivera G, Dahl G V
Blood. 1982 Oct;60(4):864-71.
Leukemia cell karyotypes were determined at diagnosis for 136 of 159 consecutive patients with acute lymphoblastic leukemia (ALL) who were followed for up to 35 mo. Ninety patients (67%) had abnormal karyotypes. Five chromosome categories were designated, based on the distribution of modal numbers: hyperdiploid greater than 50 (n = 41), hyperdiploid 47-50 (n = 18), pseudodiploid (n = 28), normal (n = 46), and hypodiploid (n = 3). Treatment response was assessed for the categories in terms of time to failure (induction failure, first relapse, or death). Children in the hyperdiploid greater than 50 category had the best responses to treatment, with only 2 failures, and those in the pseudodiploid category had the poorest (p less than 0.001). The remaining 3 chromosome categories had intermediate responses and formed a third prognostic group. This same influence of chromosome number on time to failure was evident within the 2 clinical prognostic groups: high risk, signified by a leukocyte count greater than 100 X 10(9)/liter, meningeal leukemia, mediastinal mass, or the presence of blasts that formed rosettes with sheep erythrocytes at 37 degrees C, and standard risk, indicated by the absence of these features. The influence of chromosome number on time to failure was also the same within the historically favorable prognostic group that had common ALL. Results of a multivariate analysis indicated that chromosome number was the strongest single predictor of outcome (p less than 0.001) and was the only variable that added significant prognostic information to leukocyte count (p less than 0.001). The combination of chromosome number and leukocyte count should more clearly distinguish patients with ALL at low or high risk of relapse.
对159例连续的急性淋巴细胞白血病（ALL）患者中的136例进行了诊断时白血病细胞核型测定，并对其进行了长达35个月的随访。90例（67%）患者核型异常。根据众数分布确定了五类染色体：超二倍体大于50（n = 41）、超二倍体47 - 50（n = 18）、假二倍体（n = 28）、正常（n = 46）和亚二倍体（n = 3）。根据失败时间（诱导失败、首次复发或死亡）对这些类别进行治疗反应评估。超二倍体大于50类别的儿童对治疗反应最佳，仅有2例失败，而假二倍体类别的儿童反应最差（p < 0.001）。其余3类染色体反应中等，形成了第三个预后组。染色体数目对失败时间的这种影响在两个临床预后组中也很明显：高危组，以白细胞计数大于100×10⁹/升、脑膜白血病、纵隔肿块或在37℃时与绵羊红细胞形成玫瑰花结的原始细胞存在为标志；标准风险组，以不存在这些特征为标志。在具有常见ALL的历史有利预后组中，染色体数目对失败时间的影响也是相同的。多变量分析结果表明，染色体数目是结果的最强单一预测因子（p < 0.001），并且是唯一能为白细胞计数增加显著预后信息的变量（p < 0.001）。染色体数目和白细胞计数的组合应能更清楚地区分ALL患者复发风险的高低。
