Current CLL guidelines recommend a two parallel cultures assessment using TPA and IL2+DSP30 mitogens for complex karyotype (CK) detection. Studies comparing both mitogens for CK identification in the same cohort are lacking. We analyzed the global performance, CK detection, and concordance in the complexity assessment of two cytogenetic cultures from 255 CLL patients. IL2+DSP30 identified more altered karyotypes than TPA (50 vs. 39%,p= 0.031). Moreover, in 71% of those abnormal by both, IL2+DSP30 identified more abnormalities and/or abnormal metaphases. CK detection was similar for TPA and IL2+DSP30 (10% vs. 11%). However, 11/33 CKs (33%) were discordant, mainly due to the detection of a normal karyotype or no metaphases in the other culture. Patients requiring treatment within 12 months after sampling (active CLL) displayed significantly more CKs than those showing a stable disease (55% vs. 12%,p< 0.001). Disease status did not impact cultures’ concordance (κ index: 0.735 and 0.754 for stable and active). Although CK was associated with shorter time to first treatment (TTFT) using both methods, IL2+DSP30 displayed better accuracy than TPA for predicting TTFT (C-index: 0.605 vs. 0.580, respectively). In summary, the analysis of two parallel cultures is the best option to detect CKs in CLL. Nonetheless, IL2+DSP30 could be prioritized above TPA to optimize cytogenetic assessment in clinical practice.
当前慢性淋巴细胞白血病（CLL）指南建议采用TPA与IL2+DSP30两种有丝分裂原并行培养的方法进行复杂核型（CK）检测。目前尚缺乏在同一队列中比较两种有丝分裂原对CK识别效果的研究。本研究通过对255例CLL患者的两种细胞遗传学培养结果进行分析，评估了其整体性能、CK检出率及复杂性判定的一致性。结果显示，IL2+DSP30较TPA检测出更多异常核型（50% vs. 39%，p=0.031）。在两种方法均检出异常的患者中，71%的病例通过IL2+DSP30检测到更多异常和/或异常中期分裂象。TPA与IL2+DSP30的CK检出率相近（10% vs. 11%），但33例CK中有11例（33%）存在检测不一致，主要原因为另一培养体系仅检出正常核型或无中期分裂象。取样后12个月内需要治疗的活动期CLL患者，其CK检出率显著高于疾病稳定期患者（55% vs. 12%，p<0.001）。疾病状态不影响两种培养方法的一致性（稳定期与活动期κ指数分别为0.735和0.754）。虽然两种方法均显示CK与较短的首治时间（TTFT）相关，但IL2+DSP30在预测TTFT方面较TPA具有更优的准确性（C指数分别为0.605 vs. 0.580）。综上所述，并行双培养体系是检测CLL患者CK的最佳方案，但在临床实践中可优先采用IL2+DSP30培养以优化细胞遗传学评估。
肿瘤(癌症)患者之家