儿童白血病课件.pptVIP

白细胞分化抗原 白细胞（包括血小板、血管内皮细胞等）在正常分化成熟的不同阶段以及活化过程中在这些不同谱系（lineage）细胞胞浆或细胞膜表面出现或消失的标记，参与机体重要的生理和病理过程。 诊断白血病主要标志： B-ALL: CD34, HLA-DR, CD19, CD10+/-, cCD79a T-ALL: CD34, CD38, CD7, CD2+/-, CD5+/-, cCD3 AML: CD34, CD117, CD33, CD13, cMPO M3: CD34-, HLA-DR- M2: CD19+: t(8, 21) M4/M5: CD14+ M6: GlyA+, CD71+ M7: IIb/IIIa(CD41, CD61)+ Immunology 亚型 CD19 CD34 TdT CD10 Cylg SmIg 急性早期B前体细胞白血病 Early B-precursor ALL + + + + - - 急性前B细胞白血病 Pre B-ALL + -/+ + + + - 急性B细胞白血病 B-ALL + - - - -/+ + Subtype Associated Features Hyperdiploidy (50 chromosomes) Predominant B cell precursor phenotype; low leukocyte count; favorable age group (1–9 years) and prognosis in children Hypodiploidy (45 chromosomes) Predominant B cell precursor phenotype; increased leukocyte count; poor prognosis TEL-AML1 fusion(12;21)? CD13±/CD33± B cell precursor phenotype; pseudodiploidy; age 1–9 years; favorable prognosis t(1;19)(q23;p13.3) with E2A-PBX1 fusion? CD10±/CD20–/CD34– pre-B phenotype; pseudodiploidy; increased leukocyte count; black race; CNS leukemia; prognosis depends on treatment t(9;22)(q34;q11.2) with BCR-ABL fusion? Predominant B cell precursor phenotype; older age; increased leukocyte count; dismal outcome in adults and in children with poor early response to induction or with leukocyte counts 50 x 109/liter; improved prognosis with transplant from a matched related donor? t(4;11)(q21;23) with MLL-AF4 fusion? CD10±/CD15±/CD33±/CD65± B cell precursor phenotype; infant and older adult age groups; hyperleukocytosis; CNS leukemia; dismal outcome t(8;14)(q24;q32.3) B cell phenotype; L3 morphology; male predominance; bulky extramedullary disease; favorable prognosis with short-term intensive chemotherapy including high-dose methotrexate, cytarabine, and cyclophosphamide HOX11 overexpression? CD10+ T cell phenotype; favorable prognosis with chemotherapy alone Abnormality Children Adults Hyperdiploidy (50 chromosomes) 23–26% 6–7% Hypodiploidy (45 chromosomes) 1% 2% t(1;19)(q23;p13.3) 3% in wh