摘要
目的探讨使用流式细胞术检测出的微小残留病(MRD)在急性淋巴细胞白血病(ALL)化疗阶段发生表面抗原的改变以及MRD水平、出现时期与预后关系。方法2001年10月至2006年3月北京大学人民医院儿科收治63例出现过MRD阳性的急性B淋巴细胞白血病(B-ALL)患儿,同时使用流式细胞术及PCR检测MRD。结果(1)在63例流式细胞术检测MRD阳性患儿中,有23例骨髓复发,1例脑膜白血病,6例失访,1例因严重感染死亡,33例随访至今无病生存。(2)共有147次流式细胞术检测结果呈阳性。有78次(53.06%)MRD检测结果至少有1个抗体荧光强度的变化,其中出现一个抗体强度变化的为33次(22.44%),2个抗体荧光强度变化为22次(14.96%),3个及3个以上荧光强度变化为23次(15.64%)。CD10、CD45、CD34抗体荧光强度变化频率最高。(3)共有10例患儿在复发时行免疫分型检查,8例(8/10,80%)与初治时有抗体荧光强度变化。(4)MRD为10-3水平组存活率明显低于10-4水平组(P=0.0007)。(5)维持化疗和(或)停药期间出现MRD阳性组存活率明显低于巩固化疗期间出现MRD阳性组(P=0.024)。结论在小儿B-ALL治疗过程中,MRD的免疫表型可能会发生变化,在检测过程中应加以注意。如果出现10-3水平MRD或者是在维持化疗和(或)停药期间出现MRD,应及时干预。
Objective To investigate the immunophenotypic modulation of MRD detected by flow cytometry in the course of treatment with the relationship of prognosis with the level of MRDe and the time of the appearance of MRD.Methods From 2001 to 2006,63 patients with B-ALL which occurred with MRD were enrolled.These patients were detected MRD by flow cytometry and PCR.Results 1）These were 23 patients with bone marrow relapse,1 patient with the leukemia in the central nerve system,1 patient died with severe infection,32 patients followed up were disease-free.2）A total of 147 positive results were detected by flow cytometry;78 results had the modulation of immunophenotype;33 results had one membrane antigen changed;22 results had two membrane antigens changed;23 results had three or more membrane antigens changed.The changes of fluorescent intensity of CD10,CD45,CD34 were most frequent.3）Eight of 10 patients had the immunophenotypic modulation at the time of relapse.4）Patients with MRD at the levels of 10^-3 had significantly lower disease-free survival compared with patients with MRD at the levels of 10^-3.5）Patients with positive results in the course of maintenance treatment or end of therapy had significantly lower disease-free survival compared with patients with positive results in the treatment of consolidation.Conclusion The immunophenotype of MRD of childhood B-ALL may change during the chemotherapy.We should take this into consideration during the detection.If the MRD appears in the course of maintenance treatment or end of therapy,we may take measures immediately.
出处
《中国实用儿科杂志》
CSCD
北大核心
2008年第4期276-280,共5页
Chinese Journal of Practical Pediatrics
