Lambertenghi Deliliers G, Annaloro C, Soligo D, Oriani A
Istituto di Scienze Mediche-Università degli Studi di Milano, Centro Trapianti di Midollo-Ospedale Maggiore, I.R.C.C.S. Milano, Italy.
Leuk Lymphoma. 1998 Jan;28(3-4):231-9. doi: 10.3109/10428199809092679.
Immunohistochemistry has been introduced as a means of increasing the diagnostic accuracy of bone marrow biopsy (BMB) in myelodysplastic syndromes (MDS); more recently the possibility of coupling immunostaining with other investigational techniques has broadened the spectrum of applications to the biology and physiopathology of MDS. Using panels of monoclonal antibodies (MoAbs), various histological classifications of MDS have been proposed as an alternative to the FAB criteria. The use of lineage-specific MoAbs has allowed a deeper insight into the dysplastic features of early hematopoietic precursors. The study of various gene products involved in the regulation of cell growth, proliferation and sensitivity to antineoplastic drugs, has revealed significant differences between MDS and morphologically-related disorders, particularly acute myelogenous leukemias (AML); these can be considered markers of a biological difference between the two groups of disorders and deserve consideration when designing therapeutic strategies for MDS. Both an increase in the percentage of cell positivity for the CD34 glycoprotein and a tendency of positive cells towards forming aggregates have been shown to be reliable predictors of leukemic transformation and survival, irrespective of the FAB subtype; furthermore, CD34 positivity has also proved to be a better prognostic factor than the presence of the abnormal localization of immature precursors (ALIP) on BMB. Finally, the simultaneous occurrence of "large" and CD34 positive aggregates can be proposed as a means of recognizing MDS patients with an exceedingly unfavourable prognosis, and who are therefore suitable for early aggressive therapy.
免疫组织化学已被引入，作为提高骨髓活检（BMB）对骨髓增生异常综合征（MDS）诊断准确性的一种手段；最近，将免疫染色与其他研究技术相结合的可能性拓宽了MDS生物学和病理生理学的应用范围。使用单克隆抗体（MoAbs）组合，已提出了各种MDS的组织学分类方法，作为FAB标准的替代方案。使用谱系特异性MoAbs能够更深入地了解早期造血前体细胞的发育异常特征。对参与细胞生长、增殖调节以及对抗肿瘤药物敏感性的各种基因产物的研究表明，MDS与形态学相关疾病，特别是急性髓系白血病（AML）之间存在显著差异；这些差异可被视为两组疾病生物学差异的标志物，在设计MDS治疗策略时值得考虑。已证明，CD34糖蛋白细胞阳性百分比的增加以及阳性细胞形成聚集的趋势，无论FAB亚型如何，都是白血病转化和生存的可靠预测指标；此外，CD34阳性也已被证明是比骨髓活检中不成熟前体细胞异常定位（ALIP）更好的预后因素。最后，“大”且CD34阳性聚集物的同时出现可被视为识别预后极差的MDS患者的一种方法，因此这些患者适合早期积极治疗。
