流式细胞术检测初诊儿童急性淋巴细胞白血病患者脑脊液状态与预后的相关性分析  

Correlation Analysis between Cerebrospinal Fluid Status and Prognosis in Childhood with Acute Lymphoblastic Leukemia by Flow Cytometry

作　　者：丁丽丽[1] 熊昊[1] 杨李 陈燕[2] 杜宇 卢文婕 祁闪闪 陈智[1] 孙鸣 罗琳琳 DING Li-Li;XIONG Hao;YANG Li;CHEN Yan;DU Yu;LU Wen-Jie;QI Shan-Shan;CHEN Zhi;SUN Ming;LUO Lin-Lin(Department of Hematology&Oncology,Wuhan Children's Hospital Affiliated to Tongji Medical College of Huazhong University of Science&Technology,Wuhan 430016,Hubei Province,China;Laboratory of Pediatric Hematology,Wuhan Children's Hospital Affiliated to Tongji Medical College of Huazhong University of Science&Technology,Wuhan 430016,Hubei Province,China)

机构地区：[1]华中科技大学同济医学院附属武汉儿童医院血液肿瘤科,湖北武汉430016 [2]华中科技大学同济医学院附属武汉儿童医院儿科血液医学研究室,湖北武汉430016

出　　处：《中国实验血液学杂志》2023年第3期654-658,共5页Journal of Experimental Hematology

摘　　要：目的:探讨流式细胞术(FCM)检测初诊儿童急性淋巴细胞白血病(ALL)患者的脑脊液状态及与预后的相关性。方法:回顾性分析华中科技大学同济医学院附属武汉儿童医院2020年9月至2021年12月资料完整的75例新诊断ALL患儿的临床资料、脑脊液常规细胞学(CC)检查、不同时期骨髓及脑脊液微小残留病灶(MRD)等结果。通过FCM与CC对比分析脑脊液状态,分析初诊时不同脑脊液状态患儿的临床特征及其预后。结果:75例新诊断ALL患儿中,FCM检出16例(21%)中枢神经系统浸润(central nervous system infiltration,CNSI)阳性患儿,而CC检出异常幼稚细胞2例(3%),FCM检测CNSI阳性率明显高于常规细胞学检查(P<0.05)。与CNSI^(-)ALL患儿相比,CNSI^(+)ALL患儿初诊时的中位年龄更小[2.6(0.3-12.0)岁vs 4.5(0.8-14.5)岁]且血小板中位计数更低[23(2-180)×10^(9)/L vs 65(5-355)×10^(9)/L],具有统计学差异(P<0.05)。截至随访终点(2022年8月31日),4例ALL患儿死亡,其中CNSI^(+)患儿1例;复发3例,其中CNSI^(+)患儿1例。不同CNSI状态患儿的总体生存(OS)率及无复发生存(RFS)率均无明显统计学差异。结论:对使用FCM评估初诊ALL患儿的CNSI状态比CC更敏感。初诊时不同CNSI状态的ALL患儿接受积极治疗后OS率及RFS率无明显差异。Objective: To study the cerebrospinal fluid(CSF) status and prognosis value in patients with newly diagnosed acute lymphoblastic leukemia(ALL) by flow cytometry(FCM). Methods: The clinical features of the 75 newly diagnosed ALL patients from September 2020 to December 2021 in our centre were retrospective analyzed, as well as the bone marrow(BM) and CSF minimal residual disease(MRD) data, and the CSF conventional cytology data. Central nervous system infiltration(CNSI) positive was as CSF MRD positive by FCM or leukemia cells detected by conventional cytology. The status of CSF were compared and analyzed by FCM and conventional cytology, the clinical features and the prognosis value of different CNSI status in these patients were analyzed. Results: Among 75 newly diagnosed ALL, 16 cases(21%) with CNSI positive(CNSI^(+)) were detected by FCM, while only 2 positive cases(3%) were detected by conventional cytology. The CNSI^(+) rate detected by FCM was significantly higher than conventional cytology(P0.05). Compared with CNSI^(-) ALL patients, the median age of CNSI^(+) ALL patients was significantly younger, and the median platelet count was significantly lower, the difference was statistically significant(P0.05). Up to follow-up time(August 31, 2022), four ALL patients were died, including 3 patients were CNSI^(-) and 1 patient was CNSI^(+). Furthermore, three cases were primary disease relapse, including 1 case was CNSI^(+). There was no significant difference in overall survival(OS) rate and relapse-free survival(RFS) rate of the patients with different CNSI status. Conclusion: Compared with conventional cytology, FCM is a more sensitive assay to evaluate the central nervous system status in ALL patients. After active treatment, there was no significant difference in OS and RFS between patients with different CNSI status at diagnosis.

关 键 词：急性淋巴细胞白血病 中枢神经系统浸润 流式细胞术 微小残留病 预后 

分 类 号：R733.71[医药卫生—肿瘤]