Analysis Of Clinical Value Of Cross-lineage Antigen Expression Detection In Patients With Acute Leukemia

Background The development of monoclonal antibody technology has greatly increased our understanding of leukemia cell differentiation,and the high heterogeneity of acute leukemia(AL)in immunophenotype.Many studies have shown that abnormal expression of antigen in AL may be prognosis.A poor independent predictor is also a useful marker for identifying patients with increased risk of recurrence and patients with poor cytogenetic abnormalities.Cross-lineage antigen expression Acute leukemia is currently thought to be a hypothesis of pedigree hesitant or genetically incorrect programming,but this phenomenon has not been fully explained and its regulatory mechanisms are currently unclear.Therefore,based on the previous studies,this paper attempts to analyze whether there is a unique clinical feature and possible prognostic value of the cross-lineage expressed antigen AL.Objective To analyze the clinical features of the acute leukemia patients with cross-lineage antigen expression and their possible prognostic value.Methods Flow cytometry was used to analyze the immunophenotype of AL leukemia cells.According to the immunophenotyping(EGIL)and World Health Organization(WHO)classification criteria,we reviewed the immunophenotype of 20 patients with AL who had cross-lineage antigen expression in our hospital.Characteristics,analysis of the incidence of cross-lineage antigen expression in the observation group,AL patients with cross-lineage expression of myeloid and lymphoid-associated antigens were analyzed,and their clinical characteristics,heterogeneous antigen expression characteristics and prognostic factors were analyzed.,follow-up and observe the difference in survival curves.Results (1)Clinical features: 20 patients with AL with cross-lineage antigen expression had statistically significant white blood cell counts and platelet counts at the time of initial diagnosis compared with the control group(P < 0.05),red blood cell count and peripheral blood smear original There was no statistical difference in cell count compared with the control group(P = 0.125,P = 0.66,respectively).(2)There were 15 patients with ALL in the FAB classification(5 cases of L1,6cases of L2,4 cases of L3),4 cases of AML(1 case of M1,3 cases of M2,and 3 cases of M3-M7);1 case of unknown cell classification.The results of cytochemical staining showed that the original cells were positive for POX and PAS in 10 patients.Among them,6 cases were ALL-L2,3 cases were AML?M2,and 1 case was mainly classified as unknown cells.(3)Antigen expression characteristics: Flow cytometry immunophenotyping results were the most common in 20 patients with AL.The cross-expression of B-lineage and myeloid antigen was the most common(11 cases,55%),and the cross-expression of CD33 and CD13 was the most common.There were 5 cases expressing CD117;followed by T line and myeloid antigen cross-expression(7 cases,35%),CD19,CD7 cross-expression was the most common,CD7 antigen was correlated with CD34 antigen expression;B line,T line and myeloid system The three lines had the least cross expression(1 case,5%)and expressed CD7,CD19,CD33.One case(5%)showed cross-expression of myeloid antigens CD13,CD33 and CD56.(4)Results of cytogenetics and molecular biology analysis: AML with cross-lineage antigen-positive patients and partial cross-lineage expression patients with cytogenetic and molecular biological changes,Ly+AML with reproducible chromosomal abnormalities in 4 cases,including AML 1 case with t(8;21)(q22;q22),1 case of AML with abnormal bone marrow eosinophilia inv(16)(p13;q22),AML with t(9;11)(p22;q23),2 cases of MLLT3 ? MLL.My+ ALL was associated with recurrent chromosomal abnormalities in 8 cases,including B ? ALL with t(9;22)(q34;q11.2),BCR ? ABL1 in 4 cases,B ? ALL with t(v;11q23),and MLL rearrangement.2 cases,T-ALL 14q11.2 2 cases.(5)Patients with cross-lineage antigen expression had 7 complete remissions after the first chemotherapy,and the overall remission rate was 35%,including CD7+AML(1 case,no remission),CD19+AML(2 cases,1 case remission),CD13/33.+ALL(16 cases,6 cases of relief).In the control group,30 patients were relieved after the first chemotherapy,and the total response rate was 66.7%.The total remission rate of the observation group and the control group was statistically significant(P ?0.05).The survival curves of CD7+AML group,CD19+AML group and CD56+AML group were statistically significant compared with the control group(P value was 0.01,0.02,0.02).There was no significant difference in survival curve between the CD13/33+ALL group and the control group(P > 0.05).Conclusion Flow cytometry Immunocytotyping is the primary diagnostic basis for trans-lineage antigen expression in patients with acute leukemia.Patients with positive cross-lineage antigen expression are heterogeneous.At the initial visit,the average white blood cell count of blood routine examination was higher than that of the control group,and the average platelet count was lower than that of the control group.Cross-lineage antigen-expressing AL is most commonly cross-expressed with B-lineage and myeloid antigen.Cross-expression of CD33 and CD13 is most common,some of which express CD117;secondly,T-lineage and myeloid antigen cross-expression,CD19 and CD7 cross-expression are most common.In some patients,CD34,CD7,and CD19 were co-expressed;B line,T line,and myeloid system were the least cross-expressed.Patients with positive cross-lineage antigen expression are often associated with recurrent chromosomal abnormalities.Patients in the CD7+AML group and CD19+AML group had lower remission rate and poor prognosis,and had no effect on the remission rate and prognosis in the CD13/33+ALL group.AL is a special type of leukemia with cross-lineage antigen expression.It has unique clinical features and prognostic characteristics.The diagnosis depends on flow cytometry immunophenotyping.The type of differentiation antigen expressed by cross-lineage may affect the prognosis of patients.An important factor.