Akūtu leikožu blastu analīze ar plūsmas citometrijas metodi
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Date
2020
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Rīgas Stradiņa universitāte
Rīga Stradiņš University
Rīga Stradiņš University
Abstract
Akūtas leikozes ir ļaundabīgu hematoloģisku audzēju grupa, kas attīstās blastu šūnu pārmērīgas proliferācijas un nobriešanas traucējumu rezultātā. Normālas hematopoēzes ceļā blastu šūna var nobriest divās šūnu rindās – limfoīdajā un mieloīdajā, atkarībā no tām var izšķirt akūtu leikožu apakštipus - akūta mieloīda leikoze (AML) un akūta limfoīda leikoze (ALL).
Rietumeiropā AML incidence ir 2–4 : 100 000, ALL incidence ir 1–2 : 100 000. AML pīķa saslimstības vecums ir ~65 gadi, turklāt to sastop 80% no visiem akūtu leikožu gadījumiem pieaugušo vecumā. Bērnu populācijā 5x biežāk par AML sastop ALL.
Rīgas Austrumu Klīniskās Universitātes slimnīcas (RAKUS) Latvijas Onkoloģijas centrs (LOC) ir vienīgā specializētā klīnika Latvijā, kurā tiek ārstēti akūtu leikožu pacienti pieaugušo vecumā (no 18 gadiem). Pētījuma mērķis bija apkopot un analizēt datus par pirmreizēji diagnosticētu akūtu leikožu sastopamību Latvijas pieaugušo populācijā.
Pētījumā tika iekļauti 212 pacienti (sasnieguši 18 gadu vecumu) ar primāri diagnosticētu akūtu leikozi laika posmā no 2016. gada Janvāra līdz 2019. gada decembrim. Diagnoze tika noteikta balstoties uz klīniskajām izpausmēm, laboratorajām analīzēm, blastu šūnām perifērajās asinīs, apstiprinot to ar plūsmas citometrijas izmeklējuma un kaulu smadzeņu biopsijas rezultātiem. Dati tika iegūti no RAKUS LOC Hematopatoloģijas nodaļas arhīva. Pacientu informācija tika apkopota programmā MS Excel un turpmāk analizēta ar statistikas programmas IBM SPSS starpniecību.
Rezultāti. No 212 pētījumā iekļautajiem pacientiem dzimumu skaita attiecība izrādījās vienāda – 106 sievietes un 106 vīrieši. 77,8% no visiem gadījumiem bija AML, 12,8% ALL un 9,4% akūtas nediferencētas leikozes. Pacientu pīķa saslimstības vecums bija robežās no 55-76 gadiem. Jaunākajam pētījumā iekļautajam pacientam bija 21, bet vecākajam 91 gads.
Laboratorisko analīžu atrade diagnozes noteikšanas brīdī – 92,5% pacientu tika konstatēta anēmija, 28,8% leikopēnija un 53,8% leikocitoze, savukārt, neitropēnija bija 61,8% pacientu, kamēr dažādas smaguma pakāpes trombocitopēnija – 89,2% pacientu. Biežāk sastopamie blastu šūnu virsmas marķieri AML gadījumā bija CD117+, CD33+, CD13+,
B-ALL biežākie marķieri bija CD19+, CD79a+, bet pie T-ALL visbiežāk konstatēja CD7+.
Galvenie secinājumi. Visbiežāk sastopamais akūtas leikozes tips pieaugušo populācijā pagājušo 4 gadu laikā bija AML. AML/ALL sastopamības biežuma attiecība un raksturīgais vecums bija atbilstošs epidemioloģiskajiem datiem Rietumeiropas populācijā. Biežākie blastu šūnu virsmas marķieri bija sekojoši: AML – CD117+, CD33+, CD13+, B-ALL – CD19+, CD79a+, T-ALL – CD7+.
Acute leukemia is malignant neoplastic disease that arises from disturbances in blast cell differentiation to mature hematologic cells. Blast cell can develop into myeloid and lymphoid cell line therefore changes in hematopoiesis can cause acute myeloid leukemia or acute lymphoid leukemia. In western Europe incidence of acute myeloid leukemia (AML) is 2-4:100000 and of acute lymphoid leukemia (ALL) it is 1-2:100000. Peak age of AML is ~65 years and 80% of acute leukemias in adults are acute myeloid leukemias. In children population ALL is 5x more common than AML. The objective of this research was to compile data about incidence of acute leukemias in Latvian adult population. Riga East University hospital is the only specialized clinic in Latvia where acute leukemias are treated. The study included 212 adult patients with primary diagnosed acute leukemia during period of time from January 2016 until December 2019. The diagnosis was based on positive blast cells in peripheral blood smear and flow cytometry analysis combined with clinical criteria and bone marrow biopsy results. Data were collected from the archive of Chemotherapy and Hematology clinic in Riga East University Hospitals Latvian Oncology Centre, registered in MS Excel and further analyzed with IMB SPSS statistical analysis program. Results. Out of total 212 patients 50% were male and 50% female. 77.8% of cases of leukemias were AML, 12.8% – ALL, 9.4% – acute undifferentiated leukemia. Patient mean age was 66 (55-76) years. Youngest patient was 21 and oldest – 91 years old. Laboratory blood count – 92,5 % of patients were anemic, 28,8% presented with leukopenia and 53,8% with leukocytosis. 61,8% of patients had neutropenia, 89,2% had thrombocytopenia with variable degree of severity. Most common phenotypic markers of blasts in AMLs were CD117+, CD33+, CD13+, B-ALLs presented with CD19+, CD79a+ and T-ALLs with CD7+. Conclusions. AML was the most common type of leukemia in adult population in Latvia in last 4 years. Mean age and AML/ALL distribution in Latvian adult population are similar to statistic data from Western Europe. Blast cell phenotypical markers in AML include CD117+, CD33+, CD13+, In B-ALL – CD19+, CD79a+, In T-ALL – CD7+.
Acute leukemia is malignant neoplastic disease that arises from disturbances in blast cell differentiation to mature hematologic cells. Blast cell can develop into myeloid and lymphoid cell line therefore changes in hematopoiesis can cause acute myeloid leukemia or acute lymphoid leukemia. In western Europe incidence of acute myeloid leukemia (AML) is 2-4:100000 and of acute lymphoid leukemia (ALL) it is 1-2:100000. Peak age of AML is ~65 years and 80% of acute leukemias in adults are acute myeloid leukemias. In children population ALL is 5x more common than AML. The objective of this research was to compile data about incidence of acute leukemias in Latvian adult population. Riga East University hospital is the only specialized clinic in Latvia where acute leukemias are treated. The study included 212 adult patients with primary diagnosed acute leukemia during period of time from January 2016 until December 2019. The diagnosis was based on positive blast cells in peripheral blood smear and flow cytometry analysis combined with clinical criteria and bone marrow biopsy results. Data were collected from the archive of Chemotherapy and Hematology clinic in Riga East University Hospitals Latvian Oncology Centre, registered in MS Excel and further analyzed with IMB SPSS statistical analysis program. Results. Out of total 212 patients 50% were male and 50% female. 77.8% of cases of leukemias were AML, 12.8% – ALL, 9.4% – acute undifferentiated leukemia. Patient mean age was 66 (55-76) years. Youngest patient was 21 and oldest – 91 years old. Laboratory blood count – 92,5 % of patients were anemic, 28,8% presented with leukopenia and 53,8% with leukocytosis. 61,8% of patients had neutropenia, 89,2% had thrombocytopenia with variable degree of severity. Most common phenotypic markers of blasts in AMLs were CD117+, CD33+, CD13+, B-ALLs presented with CD19+, CD79a+ and T-ALLs with CD7+. Conclusions. AML was the most common type of leukemia in adult population in Latvia in last 4 years. Mean age and AML/ALL distribution in Latvian adult population are similar to statistic data from Western Europe. Blast cell phenotypical markers in AML include CD117+, CD33+, CD13+, In B-ALL – CD19+, CD79a+, In T-ALL – CD7+.
Description
Medicīna
Medicine
Veselības aprūpe
Health Care
Medicine
Veselības aprūpe
Health Care
Keywords
Akūta mieloblastiska leikoze, Akūta limfoblastiska leikoze, Plūsmas citometrija, Blastu šūnas, Acute myeloblastic leukemia (AML), Acute lymphoblastic leukemia (ALL), Flow cytometry, Blast cells