流式细胞术及PCR技术在儿童急性B淋巴细胞白血病微小残留病监测中的价值

Value of FCM and PCR techniques in the monitoring of small residual disease in children with acute B lymphocytic leukemia

目的探讨利用流式细胞术(FCM)及聚合酶链式反应(PCR)技术在ETV6/RUNX1、E2A/PBX1或MLL基因阳性的儿童急性B淋巴细胞性白血病(B-ALL)微小残留病(MRD)监测中的价值。方法将重庆医科大学儿童医院2012年9月至2015年1月收治的初诊为B-ALL患儿61例分为A组(ETV6/RUNX1阳性)、B组(E2A/PBX1阳性)和C组(MLL阳性),并接受CCLG-ALL-2008方案治疗,治疗后不同时间点(TP)使用FCM及PCR技术检测MRD水平,并分析MRD与B-ALL预后的关系。结果 PCR检测MRD阳性率高于FCM,但差异无统计学意义(P>0.05)。A、B、C组3年无事件生存率分别为(93.1±4.7)%、(60.0±12.6)%和(62.9±17.9)%,B组FCM-MRD阴性而PCR-MRD阳性患儿全部复发。结论使用FCM或PCR技术均可有效检测儿童B-ALL的MRD水平,但PCR技术检测MRD尤其是长期随访时效果可能优于FCM。

Objective To discuss the value of monitoring minimal residual disease(MRD)by flow cytometry(FCM)and polymerase chain reaction(PCR)in pediatric B cell acute lymphoblastic leukemia(B-ALL)with fusion gene of ETV6/RUNX1,E2 A/PBX1 and MLL,to investigate sensitivity and prognosis of PCR and FCM in these patients. Methods 61 children with B-ALL suffered from September 2012 to January 2015 in Children′s Hospital Affiliated to Chongqing Medical University were divided into three groups and received therapy of CCLG-ALL-2008 protocol,which included group A(ETV6/RUNX1+),group B(E2 A/PBX1+),group C(MLL+). These patients received bone marrow asperation in different time piont(TP)and MRD level were monitored by FCM and PCR in diffirent point time. Results The positive rate of MRD was higher than FCM,but the difference was not statistically significant(P>0.05). The event free survival of 3 years for group A,B and C were(93.1 ± 4.7)%,(60.0 ± 12.6)% and(62.9±17.9)% respectively. The patients in group B with FCM-MRD negative and PCR-MRD positive all were relapsed. Conclusion Technique of FCM and PCR are both useful to monitor MRD level in pediatric B-ALL,but at the long follow-up technique of PCR may be more suitable for MRD monitoring.