Thiele J, Kvasnicka H M, Niederle N, Kloke O, Schmidt M, Lienhard H, Zirbes T, Meuter R B, Leder L D, Fischer R
Institute of Pathology, Universities of Cologne, Germany.
Am J Hematol. 1995 Sep;50(1):30-9. doi: 10.1002/ajh.2830500107.
In 55 patients with Ph1+ CML under interferon (IFN) monotherapy, an immunohistochemical and morphometric study on pretreatment bone marrow biopsies was performed to evaluate the prognostic impact of clinical as well as histological disease features. For identification of megakaryocytes we used the PAS stain and CD61 to calculate the subfraction of precursors (pro- and megakaryoblasts). Demonstration of macrophages and their different subsets was carried out by PG-M1 (CD68) and the GSA-1 lectin. The erythroid precursors were stained by Ret40f (anti-glycophorin C). Density of argyrophilic (reticulin plus collagen) fibers was determined by applying Gomori's silver impregnation method. Clinical variables like state of hematological response to IFN administration, age, spleen and liver size, myeloblasts plus promyelocytes, basophils as well as basophils and eosinophils exerted a predictive capacity by univariate statistical analysis. However, when entering these factors into previously published risk models, i.e., the so-called Sokal score and its modifications, to assess subgroups with different survival patterns or relative risk groups, a clear-cut discrimination was not feasible. Bone marrow features of prognostic value consisted of megakaryocytes and their precursors, fibers, and pro- and erythroblasts. Only when including histological variables into a formerly reported Cox model, could a significant separation of patients into the different categories or relative risk groups be computated. In conclusion, the present data emphasize the prognostic impact of histological parameters to be considered in all clinical trials on CML.
在55例接受干扰素（IFN）单一疗法治疗的Ph1+慢性粒细胞白血病（CML）患者中，对治疗前骨髓活检进行了免疫组织化学和形态计量学研究，以评估临床及组织学疾病特征的预后影响。为识别巨核细胞，我们使用过碘酸雪夫（PAS）染色和CD61来计算前体细胞（原巨核细胞和成巨核细胞）亚群。通过PG-M1（CD68）和GSA-1凝集素对巨噬细胞及其不同亚群进行鉴定。红系前体细胞用Ret40f（抗血型糖蛋白C）染色。嗜银（网状纤维加胶原纤维）纤维密度通过应用Gomori银浸染法测定。通过单因素统计分析，诸如对IFN治疗的血液学反应状态、年龄、脾脏和肝脏大小、原始粒细胞加早幼粒细胞、嗜碱性粒细胞以及嗜碱性粒细胞和嗜酸性粒细胞等临床变量具有预测能力。然而，当将这些因素纳入先前发表的风险模型，即所谓的Sokal评分及其修正模型，以评估具有不同生存模式的亚组或相对风险组时，无法进行明确区分。具有预后价值的骨髓特征包括巨核细胞及其前体细胞、纤维以及原始细胞和早幼红细胞。只有将组织学变量纳入先前报道的Cox模型时，才能计算出将患者显著分为不同类别或相对风险组的结果。总之，目前的数据强调了在所有关于CML的临床试验中应考虑组织学参数的预后影响。
