成人急性髓细胞性白血病患者的WHO分型与FAB分型的比较研究

Comparison between WHO-classification and FAB subtypes in adult acute myeloid leukemia patients

关键词:  急性髓细胞性白血病  遗传学异常  WHO分型  FAB分型

Key words:  acute myeloid Leukemia  Cytogenetics  WHO classification  FAB classification

摘要:

［目的］ 比较急性髓细胞性白血病（acute myeloid leukemia，AML）患者FAB分型和WHO分型的优缺点。［方法］联合应用骨髓细胞形态学、免疫表型检测、常规细胞遗传学技术、多重RT-PCR技术对94例患者进行检测。分别对这94例患者进行FAB分型及WHO分型。［结果］ WHO分型：AML：（1）伴有再现性遗传学异常的AML 42例；（2）伴有多系病态造血的AML 3例；（3）治疗相关性AML和MDS 0例；（4）无法按上述分型的白血病（NOC-AML）45例。FAB分型为 MDS：MDS-RAEB 1例、MDS-RAEBT 7例。AML M0 3例、M1 10例、M2 33例、M3 13例、M4 6例、M5 17例、M6 4例。对90例WHO分型诊断的AML患者进行预后评估：化疗前白细胞计数、化疗1、2次是否CR及遗传学异常对预后有影响。［结论］WHO分型全面地包括了AML的类型（原发性AML、MDS相关性AML、治疗相关性AML）；提高了遗传学检测的重要性；同时将MDS-RAEBT纳入AML范围，给予MDS-RAEBT患者及时的治疗。应推广WHO分型，但以形态学为基础的FAB分型仍不可缺少。

Abstract:

［Objective］ The comparison between the clinical practicability of the French-American-British (FAB) classification and the World Health Organization (WHO) classification of the acute myeloid leukemia (AML) was analyzed. ［Methods］ Specimens from 94 AML patients were diagnosed by bone marrow morphologic analysis, immunophenotypic, conventional cytogenetics and multiplex Reverse Transcription - Polymerase chain reaction. Patients were classified according to the FAB subtypes and the WHO subtypes. ［Results］ Using the WHO proposal, 42 patients had AML with recurrent genetic abnormalities. 3 patients had AML with multilineage dysplasia and 45 patients had WHO unclassified. According to FAB, 1 patients had myelodysplastic syndromes refractory anemia with excess of blasts (MDS-RAEB), 7 with refractory anemia with excess of blasts in transformation (MDS-RAEBT). AML-M0 to M6 were 3,10,33,13,6,17 and 4, respectively. ［Conclusion］ Our results indicate WHO classification that covers all AML subtypes, such as primary AML, MDS-related AML and therapy-related AML, enhances the importance of the cytogenetics, and includes the MDS-RAEBT subtype. But cytomorphology classification according the FAB criteria is still necessary for the diagnosis of AML.