儿童急性淋巴细胞白血病微小残留病的流式细胞术检测分析

Flow cytometry analysis of minimal residual disease in children with acute lymphoblastic leukemia

目的探讨流式细胞术检测微小残留病(MRD)在儿童急性淋巴细胞白血病(ALL)治疗中的临床价值。方法用多种四色荧光抗体组合检测50例正常儿童骨髓,据此建立双参数点图分析模型,500例ALL初发患儿行流式细胞分析,选出异于正常骨髓细胞免疫表型组合来检测MRD,根据确定好的免疫表型组合对105例患儿诱导治疗结束及后续治疗中的骨髓标本行MRD监测,同步行细胞形态学检测和PCR检测。结果流式细胞术检出462例有效MRD免疫表型组合,PCR检出142例判断MRD的融合基因或IgH/T淋巴细胞受体基因重排;细胞形态学对诱导治疗后的患儿的MRD阳性检出率为66.67%,流式细胞术的MRD阳性检出率为91.43%。结论流式细胞术能对ALL患儿治疗期间的MRD作出准确评估,具有较好的覆盖面和敏感性,值得临床应用。

Objective To investigate clinical value of detection of minimal residual disease（MRD） by flow cytometry in children with acute lymphoblastic leukemia（ALL）. Methods Various four-color fluorescent antibody combinations were used to detect normal bone marrow of 50 cases of normal children. Two-parameter point analysis template was then built accordingly. Flow cytometric was used to 500 cases of children with newly diagnosed ALL.Phenotype combinations which differred from normal bone marrow cells were selected to detect MRD. The bone marrow samples were monitored with the combination panel in 105 cases of children at the end of induction therapy and follow up treatment. Cytomor- phology test and PCR detection were performed simultaneously. Results Flow cytometry detected out 462 cases effec- tive antibody combinations to MRD. PCR detected out 142 cases fusion gene or IgH/T cell receptor gene rearrangement to MRD. MRD positive rate of children who received induction therapy by cytomorphology test reached 66.67%, 91.43% did flow cytometry. Conclusion Flow eytometry can make accurate assessment for MRD of ALL, which possess better coverage and sensitivity. It is worthy of application.