微小残留病灶对儿童急性淋巴细胞白血病预后的价值  

Prognostic value of minimal residual disease in children with acute lymphoblastic leukemia

作　　者：张巧梅 陶丹 汪燕云 张文[1] 康成[1] 张蕾 李燕平[2] Zhang Qiao-mei;Tao Dan;Wang Yan-yun;ZhangWen;Kang Cheng;Zhang Lei;Li Yan-ping(Department of Hematolog,The First Hospital of Lanzhou University,Lanzhou 730000,China;Department of Clinical Laboratory,The First Hospital of Lanzhou University,Lanzhou 730000,China;Department of Clinical Laboratory,Gansu Provincial People's Hospital,Lanzhou 730000,China)

机构地区：[1]兰州大学第一医院血液科,甘肃兰州730000 [2]兰州大学第一医院检验科,甘肃兰州730000 [3]甘肃省人民医院检验科,甘肃兰州730000

出　　处：《兰州大学学报（医学版）》2020年第1期16-21,共6页Journal of Lanzhou University（Medical Sciences）

摘　　要：目的探讨动态监测微小残留病灶(MRD)在儿童急性淋巴细胞白血病(ALL)患者诱导缓解期达到形态学完全缓解后的预后价值。方法采用流式细胞术对64例ALL患者在化疗后第33天,第12周,第6、9、12个月检测骨髓MRD。根据检测结果分为MRD阳性组和MRD阴性组。结果不同治疗时期MRD阳性组复发率显著高于MRD阴性组(P <0.05);患者化疗后第33天和第12周MRD阳性组早期复发率显著高于晚期复发率(P <0.05);经多因素分析显示:初诊高危组、初诊白细胞数≥100×10~9/L、化疗后第33天MRD阳性为影响儿童ALL复发的独立危险因素。结论利用流式细胞术动态监测MRD对预测儿童ALL预后有一定的参考意义。Objective To investigate the prognostic value of dynamic monitoring of minimal residual disease(MRD) in children with acute lymphoblastic leukemia(ALL) after induction remission therapy to achieve complete morphological remission. Methods The bone marrow MRD of 64 patients with ALL was measured by flow cytometry during chemotherapy at the 33 rd day, 12 th week, 6 th, 9 th, and 12 th month. According to the test results, the patients were divided into an MRD positive group and negative group. Results The relapse rate of the MRD positive group was significantly higher than that of the MRD negative group at different treatment periods(P < 0.05). The early relapse rate of the MRD positive group was significantly higher on the33 rd day and 12 th week(P < 0.05). Multivariate analysis showed that the newly diagnosed high-risk group,the number of newly diagnosed white blood cells ≥ 100×10~9/L, and the 33 rd day MRD positive were independent risk factors affecting the relapse in childhood ALL. Conclusion Dynamic monitoring of minimal residual disease by flow cytometry has certain reference value in predicting the prognosis of childhood acute lymphoblastic leukemia.

关 键 词：儿童 急性淋巴细胞白血病 微小残留病灶 复发 预后 

分 类 号：R446.11[医药卫生—诊断学]