儿童急性B淋巴细胞白血病缓解期外周血MDSCs的变化及意义

The change of MDSCs and its clinical significance in childhood B-lineage acute lymphoblastic leukemia during remission

目的:观察儿童急性B淋巴细胞白血病(B-ALL)缓解期患者外周血髓系来源的抑制性细胞(MDSCs)的变化,并探讨其原因及可能的意义。方法:分别抽取22例儿童B-ALL行长春新碱、柔红霉素、左旋门冬酰胺酶和强的松(VDLP)方案化疗后缓解期患者和20例健康体检儿童的外周血,流式细胞术检测和分析CD33^+HLA-DR^-/CD33^+细胞比例、以及CD14^+CD33^+HLA-DR^-和CD15^+CD33^+HLA-DR^-两群MDSCs细胞比例的变化,统计分析B-ALL患者和健康对照组之间MDSCs的差异。结果:儿童B-ALL缓解期患者外周血CD33^+HLA-DR^-MDSCs所占CD33^+细胞的比例较健康对照组明显降低(P=0.001);单核细胞来源的CD14^+CD33^+HLA-DR^-MDSCs的比例较健康对照组显著降低(P<0.01);粒细胞来源的CD15^+CD33^+HLA-DR^-MDSCs比例亦较健康对照组明显降低(P=0.004)。结论:儿童B-ALL患者行VDLP方案化疗后完全缓解期患者外周血MDSCs的比例明显下降,其低水平的MDSCs可能与化疗后机体免疫系统尚未完全正常建立相关。

OBJECTIVE：To investigate the changes,pofential role and cliniral significance of myeloid derived suppressor cells（MDSCs） in the peripheral blood of pediatric patients with B-lineage acute lymphoblastic leukemia（BALL） during remission.METHODS：22 patients with B-ALL from our hospital treated by VDLP chemotherapy regimen including vincristine,daunorubicin,L-asparaginase and prednisone were selected as the test group during remission,and 20 cases of healthy children were also selected as control group（age and gender-matched）.Peripheral blood（PB） were obtained frompatients and controls.Changes of CD33^＋ cells,CD33^＋HLA-DR^- cells,CD14^＋CD33^＋HLADR^- MDSCs and CD15^＋CD33^＋HLA-DR^- MDSCs were examined by flow cytometry,and analyzed statistically with the software of GraphPad Prisms.RESULTS：We found no change of CD33^＋ cells between the patients and control group.However,the ratio of CD33^＋HLA-DR^- /CD33^＋ cells in the patients with B-ALL during remission was lower than that in the healthy control group（P=0.001）.The ratio of both the monocyte derived CD14^＋CD33^＋HLA-DR^-MDSCs（P=0.001） and CD15^＋CD33^＋HLA-DR^- MDSCs derived from granulocytes were lower in the healthy control group（P=0.004）.CONCLUSION：MDSCs in pediatric patients with B-ALL treated by VDLP regimen during remission was often lower when compared to healthy control,the low level of MDSCs in B-ALL may be associated with the normal immunological system not recovered completely in the remission phase.