流式细胞术在急性淋巴细胞性白血病微小残留病检测中的应用

The application of flow cytometery in the detection of minimal residual disease in acute lymphoblastic leukemia

目的 用流式细胞术检测急性淋巴细胞性白血病 (ALL)患者的微小残留病 (MRD) ,为临床MRD的检测提供科学依据 ,并在此基础上 ,探讨MRD的临床意义。方法 3 3例初发白血病患者均接受 4～ 6周诱导化疗 ,获得完全缓解后 ,进行巩固化疗。在诱导化疗结束时 ,巩固化疗第 12、2 4、3 6周 ,应用流式细胞仪 (FCM)以ALL患者白血病细胞的特异分化抗原为标志监测MRD。结果 初诊时FCM检测 3 3例患者骨髓均有淋巴系分化抗原表达 ,在诱导化疗结束时 ,巩固化疗第 12、2 4、3 6周 ,FCM检测MRD检出率分别为 42 4%、3 1 3 %、13 8%、12 5 %。在按年龄 (以 18岁为界 )、性别、初发病时白细胞计数 (5 0×10 9/L为界 )、Ph染色体、My表达、CNSL等因素分别分组中 ,各个时间段MRD的检出率均无差别。MRD阳性及白细胞计数大于 5 0× 10 9/L(P <0 10 )为复发的高危因素。结论 ①白细胞分化抗原可作为免疫学标志用FCM方法检测ALL患者的MRD。②MRD与临床复发高度相关。③MRD可能为ALL患者一个独立的预后不良的因素。

Objective To approach the clinical significance of MRD using flow cytometery for detecting minimal residual disease(MRD)in acute lymphoblastic leukemia. Methods Thirty three patients with newly diagnosed ALL received remission induction chemotherapy for 4～6 weeks.Once completeremission was attained,the patients received consolidation therapy Bone marrow aspirates were collected after induction therapy and during weeks 12,24 and 36 of continuation therapy Cells with leukemia associated immunophenotypes were investigatedby flow cytometery,as immunologic target of MRD. Results At the beginningof disease lympho linge immunophenotype expressed in bone marrow of 33 patients,whileafter induction therapy and during weeks 12,24 and 36 of continuation therapy,the detectable rates of patients with MRD were 42 4%,31 3%,13 8% and 12 5%,respectively In different groups(based on age,sex,WBC counts,My expression,Ph chromosome and CNSL)the difference of detectable rates had no statistical significance MRD positive and WBC counts more than 50×10 9/L were the risk factors of ALL relapse( P <0 10) Conclusion ALL assotiated immunophynotype can be used as a target for detecting MRD in ALL.MRD may be an independent predictor risk of relapse.