流式检测骨髓正常浆细胞在多发性骨髓瘤疗效评估中的价值  

Value of detection of normal plasma cells with flow cytometry in evaluating the efficacy of multiple myeloma

作　　者：金鑫[1] 陆玲娜 周梦 周雯霏 JIN Xin;LU Lingna;ZHOU Meng;ZHOU Wenfei(Department of Blood Transfusion,Tongde Hospital of Zhejiang Province,Hangzhou,310012,China;Department of Hematology,Tongde Hospital of Zhejiang Province)

机构地区：[1]浙江省立同德医院检验科,杭州310012 [2]浙江省立同德医院血液科

出　　处：《临床血液学杂志（输血与检验）》2020年第5期678-681,共4页Journal of Clinical Hematology(Blood Transfusion & Laboratory Medicine)

基　　金：浙江省医药卫生科技计划面上项目(No:2019KY048)。

摘　　要：目的:探讨流式检测骨髓正常浆细胞在多发性骨髓瘤治疗后监测中的价值。方法:回顾性分析2016—2019年218例多发性骨髓瘤患者治疗后,骨髓形态学及流式复查结果,其中包括化疗后复查194例、自体干移植后复查19例、CAR-T后复查5例;以形态学浆细胞比例是否<5%将所有复查结果分为完全缓解(CR)组及未达CR组,同时,依据流式检测中有无检出异常或正常浆细胞,将所有复查结果分为检出异常浆细胞组、检出正常浆细胞组、未检出正常浆细胞组、同时检出异常及正常浆细胞组;分析各组形态学浆细胞比例、流式异常正常浆细胞比例、异常/正常浆细胞比值,以及同期血清免疫固相电泳、免疫球蛋白、β2微球蛋白的关系。结果:218例复查结果中,形态学CR组126例,未达CR组92例,形态学CR组结果中,流式检出正常浆细胞例数显著高于未达CR组(P<0.05)。218例流式分组结果,检出异常浆细胞组共178例,异常浆细胞比例与形态学浆细胞比例呈高度正相关(r=0.873),但流式比例明显低于形态学比例(P<0.05);检出正常浆细胞组共129例,其流式及形态浆细胞比例、免疫球蛋白、β2微球蛋白均显著低于未检出正常浆细胞组(P<0.05)、血清免疫固相电泳转阴例数显著高于未检出组(P<0.05);同时检出异常及正常浆细胞组共89例,其异常/正常浆细胞比值与流式异常浆细胞比例、骨髓形态学比例均呈高度正相关(r=0.848、0.619)。结论:多发性骨髓瘤患者骨髓复查中出现正常浆细胞是肿瘤负荷下降的标志,异常/正常浆细胞比值在疗效评估有一定的价值,建议流式报告中常规描述。Objective:To investigate the value of detection of normal plasma cells in bone marrow by flow cytometry in monitoring of multiple myeloma.Method:A retrospective analysis was performed on 218 results of bone marrow morphology and flow cytometry of multiple myeloma patients treated in our hospital from 2016 to 2019,including 194 cases after chemotherapy,19 cases after autologous stem cell transplantation,and 5 cases after CAR-T.All review results were divided into CR group and non-CR group based on whether the proportion of plasma cells was<5%by morphology.Meanwhile,all results were still divided into abnormal plasma cell group,normal plasma cell group,no normal plasma cell detected group,and both abnormal and normal plasma cell detected group according to the test by flow cytometry.The relationship among proportion of the normal and abnormal plasma cells detected by flow,ratio of abnormal/normal plasma cell,the proportion of plasma cells by morphology,immunosolid phase electrophoresis,β2-MG and immunoglobulin in different groups were analyzed.Result:Among the review results of 218 cases,126 cases were in the CR group and 92 cases in the non-CR group,and the number of cases which detected normal plasma cells by flow in the CR group was significantly higher than that in the non-CR group(P<0.05).There were 178 cases in the abnormal plasma cell group,the proportion of abnormal plasma cells detected by flow was highly correlated with that of morphology(r=0.873),and was significantly lower than that of the morphology(P<0.05).Meanwhile all of the results were divided into two groups according to whether normal plasma cells were detected,total 129 cases of normal plasma cells were detected by flow.The proportion of plasma cells by flow and morphological,immunoglobulin andβ2-MG in the detected group were significantly lower than those in the undetected group(P<0.05),as well,the number of cases turning negative by immunosolid phase electrophoresis was significantly higher than that in the undetected group(P<0.05).The rati

关 键 词：流式细胞术 多发性骨髓瘤 正常浆细胞 

分 类 号：R733.3[医药卫生—肿瘤]