微小残留病灶监测在多发性骨髓瘤的临床预后应用

Significance of minimal residual focus detection in prognosis of patients with multiple myeloma

目的探讨流式细胞仪(FCM)检测追踪多发性骨髓瘤(MM)患者骨髓微小残留病灶(MRD)变化的临床预后应用。方法应用FCM以骨髓瘤细胞(MC)特异分化抗原为标志检测48例初治MM患者MRD,并与传统骨髓形态学检查结果进行比较。结果FCM检测显示124份标本中共有108份标本MRD阳性,其中21份标本MC≥0.05,有87份标本MC≥0.0001且<0.05,有16份标本MC<0.0001(MRD阴性),其中骨髓确诊复发的有10例,其中7例患者MRD持续阳性于4～28个月后出现骨髓复发,比骨髓象诊断复发平均提前10个月,预测各组患者复发的敏感性均为100%,特异性分别为完全缓解(CR)1～12个月组为22.2%(2/9),CR13～24个月组为66.6%(2/9),CR>25个月组为66.6%(2/3),差异有统计学意义(χ2=13.47,P<0.05)。结论利用FCM能够对MM进行MRD监测预测复发,治疗初期患者MC>0.0001,复发的危险性高,连续定期动态观察对提示复发、预测预后及指导个体化治疗有重要意义。

Objective To investigate the clinical significance of minimal residual focus（MRD）detection in prognosis of patients with multiple myeloma（MM）.Methods MRD in 48 patients with MM were detected by FCM with idio-differentiation antigen as marker,and the results were compared with those detected by traditional bone marrow cells morphology.Results Of 124 bone mallow samples,MRD were positive in 108 samples,including 21 samples with myeloma cells≥0.05,87 samples with myeloma cells from 0.0001 to 0.05,and 16 samples with myeloma cells 〈0.0001（MRD negative）.10 patients were diagnosed as relapse based on bone marrow cells morphology,of which 7 were continually positive in MRD and diagnosed relapse 4～28 months later（10 months before traditional bone marrow cells morphology assay）.The average sensibility in predicting relapse were all 100% and the specificity were 22.2% in CR 1～12 months group,66.6% in CR 13～24 months group and 66.6% in CR more than 25 months group,showing significant differnence（χ2=13.47,P〈0.05）.Conclusions Relapse of AL can be predicted by MRD monitor with the use of FCM.If MRD was positive in the early phase of treatment,the risk of relapse was higher.The accuracy can be increased by means of continous and regular monitor,which have important clinical significance in guiding chemotherapy,predicting relapse and selecting individualized treatment.