急性淋巴细胞白血病患儿骨髓微小残留病检测的临床意义  

Clinical Significance of Minimal Residual Disease in Childhood Acute Lymphoblastic Leukemia

作　　者：张志向[1] 柴忆欢[1] 何海龙[1] 王易[1] 胡绍燕[1] 赵文理[1] 李建琴[1] 卢俊[1] 肖佩芳[1] 季正华[2] 计雪强[2] 

机构地区：[1]苏州大学附属儿童医院血液科,江苏苏州215003 [2]苏州大学附属儿童医院检验科,江苏苏州215003

出　　处：《实用儿科临床杂志》2010年第15期1133-1135,共3页Journal of Applied Clinical Pediatrics

基　　金：国家科技支撑计划课题(2007BA104B03)

摘　　要：目的探讨流式细胞术(FCM)检测ALL患儿骨髓微小残留病(MRD)对预测复发及指导治疗的临床意义。方法采用FCM以多种四色荧光抗体组合检测健康儿童骨髓,建立健康儿童骨髓细胞双参数点图分析模板;对119例ALL初诊患儿的骨髓细胞进行MRD筛选,找出在双参数点图上的位置明显区别于正常骨髓细胞的免疫表型组合作为MRD监测的有效免疫表型组合,用这些有效免疫表型组合对ALL患儿诱导治疗结束及巩固治疗前的骨髓标本进行MRD监测。结果 119例ALL患儿诱导化疗末期,完全缓解率100%。MRD监测阴性85例,4例(4.7%)复发;MRD阳性34例,7例(20.6%)复发。MRD阴性患儿与阳性患儿复发率比较差异有统计学意义(P<0.05)。巩固治疗前监测骨髓MRD阴性者89例,2例(2.2%)复发;MRD持续阳性或由阴性转为阳性者共30例,其中9例(30.0%)复发,其差异有统计学意义(P<0.01)。根据疾病危险度分为3组:标危组80例,中危组27例,高危组12例,完全缓解时MRD阴性及阳性率在3组间差异均有统计学意义,其中高危组、中危组MRD阳性率显著高于标危组(Pa<0.05)。结论应用FCM动态检测MRD,可以了解疗效及初步判断其预后,以便调整治疗策略,是目前随访儿童ALL的有效方法 。Objective To evaluate the clinical significance of minimal residual disease（MRD） in childhood acute lymphoblastic leukemia（ALL） in order to predict relapse and guide clinical practice.Methods A variety of four-color fluorescent antibody combinations were used to investigate the children′s normal bone marrow.The normal bone marrow pattern at two-parameter plots was established and used as templates to identify the residual tumor cells.By using four-color cytometry analyzed 119 bone marrow from newly diagnosed ALL children were analyzed and antibody combinations were determined,which might clearly distinguish the tumor cells from normal cells.Useful immunophenotype combinations were found in 119 children and MRD in born marrows were monitored at the end of induction therapy and follow-up treatment.Results At the end of induction chemotherapy,119 cases with ALL achieve complete remission （CR） 100%,4 cases with negative MRD relapsed （4.7%） among 85 negative cases detected;while 7 cases with positive MRD had recurrence （20.6%）,and the recurrence rate between the 2 groups was different statistically （P〈0.05）.Among 89 negative bone marrow MRD monitored before consolidation therapy,2 cases relapsed （2.2%）.Nine （30.0%）out of 30 children,who had been positive or negative to positive,had relapsed,and there were significant differences in relapse rate between the positive MRD and negative MRD （P〈0.01）.Of the 119 children,80 children had standard risk;27 children had intermediate risk and 12 children were at a high risk.The MRD positive rate was significantly different among these children with different degrees of risk,and the high risk and intermediate risk children had highest MRD positive rate,followed by the standard risk children（Pa0.05）.Conclusion The dynamic detection of MRD by FCM can be used to evaluate the therapeutic effect and the prognosis of childhood ALL so as to adjust treatment strategy and is the effective method for follow-up in children with ALL.

关 键 词：淋巴细胞白血病 急性 微小残留病 复发 儿童 

分 类 号：R733.71[医药卫生—肿瘤]