儿童恶性血液肿瘤骨髓微量残留病检测及其临床意义

Detection of minimal residual disease in childhood hematological malignancies and its clinical significance

目的 探讨以恶性血液肿瘤患儿骨髓微量残留病检测预测预后的可能性。方法 选择75例完全缓解期急性淋巴细胞白血病或Ⅳ期非霍奇金淋巴瘤或Ⅳ期神经母细胞瘤患儿 ,骨髓及临床持续缓解 3个月以上。神经母细胞瘤患儿采用反向聚合酶链反应 (PCR)测定骨髓微量残留病 ;其余患者以IgH及TCRγ基因重排为标志 ,用PCR测定骨髓微量残留病。结果 35例患者骨髓微量残留病阳性 ,随诊结果 2 1例于测定后 3～ 40个月复发 (6 0 % ) ;阴性 40例 ,7例复发 (17% ,χ2 =12 .5 9,P <0 .0 1)。结论 提示部分恶性血液肿瘤患儿用PCR检测骨髓微量残留病可预测临床预后。

Objective Expoloring the detection of minimal residual malignant cells in bone marrow from children with hematological malignancies to predict the prognosis. Methods Seventy five patients with acute lymphoblastic leukemia(ALL), stage Ⅳ non Hodgkin's lymphoma or stage Ⅳ neuroblastoma were studied. Complete remission was maintained for over 3 months before the detection. Minimal residual disease was detected by polymerase chain reaction(PCR) for IgH and TcRγ rearrangements in lymphoid tumors by reverse transcriptase polymerase chain reaction (RT PCR) for neuroblastoma patients. Results Thirty five patients were positive for minimal residual disease, and 21 of them (60%) relapsed 3～40 months later, while only 7 (17%) negative patients relapsed (χ 2=12.59, P<0.01). Conclusion Minimal residual disease detection in bone marrow by PCR might predict prognosis in some childhood hematological malignancies.