Clinical Reaserch Of Acute Monocytic Leukaemia

[Objective] To analyze the clinical,immunophenotypic,cytogenetic characteristics of acute monocytic leukaemia and the main factors that influence whose survival and prognosis.[Method] 183 patients were enrolled,clinical feature,immunophenotype, chromosome karyotype were analyzed.The factors those influence the complete remssion(CR),overall survival (OS) and disease-free survival (DFS) were statistically analyzed of 158 patients who received chemotherapy.[Result] 1,acute monocytic leukaemia is a distinct subtype with characteristic clinical features associated with hyperleukocytosis, extramedullary involvement,and coagulation abnormalities.The patients with M5 counted for 26.9% of all AML. Of the 183 patients,88.5% patients had M5b. The median age for all M5 patients was 40 years (range,13 to 67 years).The frequencies of patients with coagulation abnormalities and extramedullary infiltration were 32.4% and 71.6% ,respectively.There were 44.8% patients with WBC counts≥30×109/L,19.1% patients with WBC counts≥100×109/L,14.2% patients with pancytopenia. The bone marrow of most patients (74.3%) was hyperplasia.2,Bone marrow samples of the 172 cases with M5 were received immunophenotypic examination, CD7 included.T lineage associated antigens were expressed in 40.7% patients.CD11b and CD14 were highly expressed in patients with CD56(+) patients,there was obvious difference between CD56(-) and CD56(+) groups through statistical analysis,the P values were 0.035,0.001,respectively. The 1 and 3 years OS,DFS rates of CD11b(-),CD64(-)were higher than CD11b(+), CD64(+) through univariate analysis, the P values were 0.002,0.003, respectively.3,The chromosome karyocytes were analyzed of 161 patients,normal and abnormal chromosome karyotypes counted for 55.9% and 40.4%, respectively.The abnormal chromosome karyotypes included patients with abnormalities with 11q23,+8,9q/del(9q),complex karyocytes and so on. there were 6 patients who didn't have mitosis. The CR rate with normal chromosome karyotypes was higher than those with abnormal chromosome karyotypes.The CR rate,OS and DFS rates of intermediate prognostic group were higher than the poor prognostic group,but there were no differencese between intermediate prognostic group and unknown group. 4,158 patients received induce therapy,the CR rate was 74.1%, the CR rate was higher for the patients who received mHAD (25/29,86.2%) than the others (81/129,62.8%).The OS rate of the patients who received mHAD was higher than the patients who received HAD,MA and HAA.The OS and DFS rates of the patients who received intermediate dose Ara-C were higher than the standard dose Ara-C group in induce and consolidation therapy.Patients who received more courses of consolidation therapy may have a better survival.5,Chromosome karyotype, CD11b(+) and the course of consolidation therapy had more important influence on survival through COX analysis.[Conclusion] 1,Acute monocytic leukaemia is easily associated with hyperleukocytosis,extramedullary involvement,and coagulation abnormalities.2,The phenomenon of antigen across was common in M5.CD 1 lb and CD 14 were highly expressed in M5 patients with CD56 (+);3,There were many abnormal chromosome karyotypes in M5 and poor prognostic karyotypes were common. The CR rate,1 and 3 years OS,DFS rates were low.4,Intensive chemotherapy(including induce chemotherapy and post- remission chemotherapy) can improve CR and survival rate. chromosome karyotype, CD11b(+) and the courses of consolidation therapy had important influence on survival.