儿童急性B淋巴细胞白血病微小残留病检测及其预后意义

Detection of minimal residual disease in childhood acute B lymphoblastic leukemia and its prognostic significance

目的建立检测急性B淋巴细胞白血病(B-ALL)微小残留病(MRD)的流式细胞术,评估监测MRD对于判断B-ALL预后的价值。方法用四色荧光抗体组合流式细胞术对33例确诊并接受SCMC-ALL-2005方案治疗的B-ALL患儿进行MRD检测,并随访5年,分析监测结果、复发率、5年无事件生存率。结果建立了正常骨髓细胞分布的分析模板;流式细胞术检测结果表明,18例MRD阳性患儿的白血病复发率为55.6%(10/18)、15例MRD阴性患儿复发率为13.3%(2/15),差异有统计学意义(P<0.05)。其5年无事件生存率分别为44%和93%,差异有统计学意义(χ2=6.37,P<0.05)。结论监测MRD对于B-ALL患儿预后评估有重要意义,并为治疗方案的选择提供依据。

Objective To establish a flow cytometric method for detecting minimal residual disease（MRD） in acute B lymphoblastic leukemia（B-ALL） and evaluate the prognostic significance of monitoring MRD.Methods MRD in 33 children with definitely diagnosed B-ALL receiving SCMC-ALL-2005 protocol treatment was detected by four-color fluorescence flow cytometry.All the enrolled children received follow-up visit for five years.The results of MRD detection,relapse rate and 5-year event-free survival rate were analyzed.Results The analysis templates for the distribution of normal bone marrow cells were established.The relapse rates of 18 MRD-positive and 15 MRD-negative children were 55.6%（10/18） and 13.3%（2/15） respectively,and a difference with statistical significance（P＆lt;0.05） was found.The 5-year event-free survival rates were 44% and 93% respectively in the two groups with significant difference（χ2=6.37,P＆lt;0.05）.Conclusion The results of MRD detection showed clinical importance in prognostic assessment and may provide the reference for the selection of therapeutic protocol for children with childhood B-ALL.