治疗终止后儿童急性淋巴细胞白血病微小残留病的检测及临床意义探讨

Detection of Minimal Residual Disease of Acute Lymphoblastic Leukemia in Children After Termination of Therapy

以IgH和TCRγ两种基因重排为标志,通过多聚酶链反应(PCR)检测治疗终止后儿童急性淋巴细胞白血病(ALL)微小残留病(MRD).受检的18例病人中(化疗者11例,自体造血干细胞移植者7例),有9例于治疗终止后仍可检出MRD;其中的3例在检测后6个月内复发.治疗终止后未检出MRD的9例中无1例复发.化疗组与移植组MRD检出率无显著性差异(P=0.50)我们认为,治疗终止后仍可检出MRD者,其复发的危险性大,应定期监测体内MRD的变化.文中探讨了MRD检测的临床意义.本文应用的从存档骨髓涂片中提取NDA的方法具有简单、快速、可靠等优点.

With the IgH and TCR gene rearrangements as markers, we detected minimal residual disease (MRD) in children with acute lymphoblastic leukemia who were after cessation of therapy in complete remission,by use of the polymerase chain reaction. Among 18 patients (11 treated with chemotherapy, 7 with transplantation of autogenous hemopoietic stem cells), MRDs were detected in 9 cases,three of them relapsed within 6 months after detection. Among the 9 MRD-negative cases.no one relapsed. There was no significant statistical difference between these two groups (P = 0.50).We suggested that patients with MRD after the termination of therapy were at a high risk of relapse in the near future and their MRDs should be monitored periodically. The clinical implications of the detection of MRD were discussed in this article. The method of extracting DNA from archival bone marrow smears was used in this study.it has the advantages of simplicity .quickness, reliability ,et al.