18例急性B淋巴细胞白血病患者初诊与复发白血病相关免疫表型的改变  

Leukemia-associated immunophenotypic changes between diagnosis and relapse in acute B lymphoblastic leukemia from 18 patients

作　　者：许艳丽[1] 王顺清[1] 毛平[1] 杜庆华[1] 

机构地区：[1]广州市第一人民医院血液科,广州510180

出　　处：《临床血液学杂志》2014年第3期390-392,396,共4页Journal of Clinical Hematology

摘　　要：目的:探讨急性B淋巴细胞白血病(B-ALL)患者初诊与复发时白血病相关免疫表型的变化。方法:采用流式细胞术检测方法,对比分析18例B-ALL患者初诊与复发免疫表型,以复发时获得新的异常表型或丢失原有的异常表型,或异常表型荧光强度的增加或降低定义初诊与复发的免疫表型变化。结果:17例(94%)患者出现至少1个及以上异常表型的变化。10例(56%)患者出现新的异常表型,由初诊的表型阴性转为阳性;9例(50%)患者出现由阳性转为阴性的表型变化。9例(50%)患者部分阳性抗原复发时荧光强度显著增加,11例(61%)患者荧光强度显著降低,但仍表现为阳性。5例(28%)患者异常表型的获得与丢失同时存在。CD45为最稳定的标记,18例复发患者与初诊比较未发生显著变化。CD19在1例患者中初诊为阴性,复发时转为CD19阳性。可检测的抗原标记共计146个,其中发生表型变化的抗原标记占46%(67/146)。结论:复发与初诊的表型发生变化比较普遍,采用初诊的异常表型设门策略进行微小残留病灶检测可能会遗漏一些阳性患者,ALL患者微小残留病灶及复发诊断的监测应基于多个抗体组合和多个异常免疫模式的认定。Objective：To explore the leukemia-associated immunophenotypic shifts between diagnosis and relapse in acute B lymphoblastic leukemia（B-ALL）.Method：Eighteen patients with B-ALL were immunophenotyped by flow cytometry at diagnosis and at relapse.Phenotypic changes were characterized by the gain or loss of immunophenotypic aberrancies or increased or decreased intensity.Result：Immunophenotype shifts of aberrant antigen expression occurred in 17patients（94%）between diagnosis and relapse.The newly aberrant phenotypes were observed in 56% of cases,which were converted from negativity at diagnosis to positivity at relapse,inversely,changes from positivity to negativity were observed in 9patients（50%）.Increased or decreased intensities of antigen at relapse were observed in 9cases（50%）and 11cases（61%）respectively,the changed phenotypes were still positive.Gain and loss of aberrancy were both presented in 5cases（28%）.CD45was more stable marker compare to 15aberrant antigens,there was no significant change between relapse and diagnosis in 18cases.CD19was converted from positivity at diagnosis into negativity at relapse in one case.Antigen changes were observed in 67of 146 antigens（46%）expressed in 18patients.Conclusion：Phenotypic shifts are common,but MRD analysis may have missed many positive cases if rigid abnormal phenotypes gating is used at diagnosis.Multiple panels of more McAbs and multiple aberrancy patterns of detection are likely to be required in the monitoring of MRD and diagnosis of relapse in B-ALL by flow cytometry.

关 键 词：多参数流式细胞术 免疫分型 急性B淋巴细胞白血病 

分 类 号：R733.71[医药卫生—肿瘤]