微小残留病阳性儿童B系急性淋巴细胞白血病的追踪分析

Progression of children with minimal residual disease of positive B lineage acute lymphocytic leukemia

目的探讨儿童B系急性淋巴细胞白血病(B-ALL)患儿骨髓微小残留病(MRD)及检测,预测预后的可能性。方法应用四色荧光抗体标记法通过流式细胞仪检测儿童B-ALL的MRD。对41例MRD阳性患儿加强化疗强度,多次连续监测,进行追踪分析。结果41例MRD阳性患儿中复发6例,复发患儿的MRD均>0.1%,MRD出现阳性的时间均>3个月,临床分型都属高危型。MRD阳性患儿经1个疗程强烈化疗转阴27例,其中1例复发,其他均在随访中,中位随访时间24.8个月;MRD阳性2个疗程转阴14例,复发5例,缓解患儿中位随访时间22.8个月。结论MRD对B-ALL预后监测有重要意义,MRD阳性时间越长对预后越不利,加强对MRD阳性患儿的治疗对改善预后有积极作用。

Objectives To investigate the possibility of predicting the outcome in children with B lineage acute lymphocytic leukemia （ALL） by monitoring minimal residual disease （MRD） in bone marrow. Methods Four color fluorescence antibody labeling method was used to monitor the dynamic changes of the MRD in children with B lineage ALL. Forty-one （41） children with positive MRD were treated by intensified chemotherapy and were followed up. Results Six patients relapsed among total 41 children with positive MRD, The characteristics of these relapsed children were as follows. （1） MRD positive rate was over 0.1%; （2） The time of MRD to become positive was over 3 months; （3） They all belonged to high risk group in accordance with the clinical stratification. Twenty-seven （27） of these positive MRD cases turned to negative MRD by one course of intensified chemotherapy, however one of them relapsed afterwards. These MRD negative cases were closely followed up with a median duration of 24.8 months. The other 14 children with positive MRD became MRD negative after 2 courses of the intensified chemotherapy, while 5 children relapsed. The median follow-up duration was 22.8 months for patients with complete remission. Conclusions Longer time of MRD positive cases had poor outcome. Monitoring dynamic changes of MRD is important to predict prognosis of B cell ALL children, and is helpful in treating MRD positive patients to improve their prognosis.