胞浆轻链测定在多发性骨髓瘤的微小残留病变检测中的价值  被引量:1

Value of cytoplasm light chain detection in minimal residual disease of multiple myeloma

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作  者:赵英男[1] 朱杰[2] 

机构地区:[1]武警辽宁总队医院大连分院检验科,116013 [2]大连医科大学第二临床学院检验科,116027

出  处:《武警医学》2014年第1期9-12,15,共5页Medical Journal of the Chinese People's Armed Police Force

摘  要:目的 探讨胞浆轻链检测在多发性骨髓瘤(multiple myeloma,MM)微小残留病变(minimal residual disease,MRD)检测的价值.方法 采用四色流式细胞术,用CD45-APC/SSC及CD38/CD56/CD19及CD138联合设门,通过检测胞浆内轻链(cκ链、cλ链)对45 例经治疗后已完全缓解MM患者(治疗前已经过上述免疫分型检测)的骨髓标本进行微小残留病变的检测,同时进行跟踪随访,分析MRD对MM患者的复发率和无病生存时间是否存在影响.结果 45例骨髓瘤患者中分泌型为37例(其中IgG型为27例,IgA型为10例),轻链型为5例(λ链型4例,κ链型1例),不分泌型3例.表型为CD38+CD56+CD19-CD45-出现的频率为,分泌型中100% (37/37),轻链型20%(1/5),不分泌型0%(0/3);表型为CD38+CD56-CD19-CD45-为,轻链型80%(4/5),不分泌型100%(3/3).CD138+,100%(45/45);胞浆轻链(cκ链、cλ链),100%(45/45),其中分泌型:cκ链27%(10/37);cλ链:73%(27/37);轻链型:cκ链20%(1/5),cλ链:80%(4/5);不分泌型:cκ链33%(1/3),cλ链:67%(2/3),经治疗缓解后进行MRD检测,免疫表型为CD38+CD56+CD138+CD19-CD45-MRD阳性率为18%(7/38),免疫表型为CD38+CD56-CD138+CD19-CD45-MRD阳性率为100%(7/7),两组比较有统计学意义(P〈0.05),cκ链组MRD阳性率为25%(3/12),cλ链组33%(11/33),两组比较差别无统计学意义.随访24个月后,MRD阴性组复发率13%(4/31),MDR阳性组复发率为71%(10/14),两组复发率比较,差异有统计学意义(P〈0.05).MRD阴性组累积无病生存时间中位数15.53(9.35-21.62)个月,明显长于MRD阳性组的9.75(3.69-14.24)个月,两组比较差异有统计学意义(P〈0.05).结论 胞浆轻链测定在多发性骨髓瘤的微小残留病变检测中可以作为临床判断预后的重要指标,并对临床开展相关治疗有指导意义.Objective To study the role of light chain detection in the minimal residual disease (MRD) of multiple myeloma (MM). Methods The light chains of 45 bone marrow samples from the patients who were diagnosed as having MM and showed complete remission after some treatments were tested using four color flow cytometry (CD45)APC/SSC, CD38/CD56/CD19 and CD138 were detected together). The positive rate of MRD was determined according to the results of flow cytometry and the progression of the disease of each patient was followed up. After that, whether the positive rate of MRD affected recurrence rate and disease free survival (DFS) of MM was analyzed. Results Among the 45 cases, 37 were of secretory type (IgG 27 cases; IgA 10 cases) ; 5 were of light chain type ( λ chain : 4 cases ; K chain : 1 case) and 3 were of un-secretory type. As the frequency of immunophenotype, 37/37 ( 100% ) secretory type, 1/5 (20%) light chain type and 0/3 (0%) showed CD38 ^+ CD56 ^+ CD19^-CD45^- ; 4/5 ( 80% ) light chain type and 3/3 (100%)un-secretory type showed CD38 ^+ CD56^-CD19^-CD45^- ; 100% (45/45) cases showed CD138 ^+ and light chain in cyto- plasm positive. Among secretory type cases, 10/37(27% )was cK chain and 27/37 (73%)was cg chain. Among light chain type cases, 1/5(20% )was ck chain and 4/5(80% )was cκ chain. Among un-secretory type cases, 1/3(33% )was cKchain and 2/3(67% ) was c~. chain. After treatment, the samples from the complete remission patients were tested again. The positive rate of CD38 ^+ CD56 ^+ CD138 ^+ CD19-CD45 was 7/38( 18% ) ,which was significantly lower than that of CD38^+ CD56^-CD138 ^+ CD19^+CD45^- (7/7, 100% ), P 〈 0.05. And there was no significant difference in MRD between cg chain (3/12, 25% ) and cκ chain ( 11/33, 33% ), P 〉 0.05.After 24 months' follow-up, the recurrence rate in negative MRD group was 13% (4/31), which was significantly lower than that in positive MRD group �

关 键 词:多发性骨髓瘤 免疫表型 胞浆轻链 流式细胞术 微小残留病变 

分 类 号:R733.71[医药卫生—肿瘤]

 

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