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目的探讨流式细胞术(FCM)检测ALL患儿骨髓微小残留病(MRD)对预测复发及指导治疗的临床意义。方法采用FCM以多种四色荧光抗体组合检测健康儿童骨髓,建立健康儿童骨髓细胞双参数点图分析模板;对119例ALL初诊患儿的骨髓细胞进行MRD筛选,找出在双参数点图上的位置明显区别于正常骨髓细胞的免疫表型组合作为MRD监测的有效免疫表型组合,用这些有效免疫表型组合对ALL患儿诱导治疗结束及巩固治疗前的骨髓标本进行MRD监测。结果 119例ALL患儿诱导化疗末期,完全缓解率100%。MRD监测阴性85例,4例(4.7%)复发;MRD阳性34例,7例(20.6%)复发。MRD阴性患儿与阳性患儿复发率比较差异有统计学意义(P<0.05)。巩固治疗前监测骨髓MRD阴性者89例,2例(2.2%)复发;MRD持续阳性或由阴性转为阳性者共30例,其中9例(30.0%)复发,其差异有统计学意义(P<0.01)。根据疾病危险度分为3组:标危组80例,中危组27例,高危组12例,完全缓解时MRD阴性及阳性率在3组间差异均有统计学意义,其中高危组、中危组MRD阳性率显著高于标危组(Pa<0.05)。结论应用FCM动态检测MRD,可以了解疗效及初步判断其预后,以便调整治疗策略,是目前随访儿童ALL的有效方法 。
Objective To investigate the clinical significance of Flow Cytometry (FCM) in the detection of bone marrow minimal residual disease (MRD) in ALL patients in predicting relapse and guiding therapy. Methods FCM was used to detect the bone marrow of healthy children by a variety of four-color fluorescent antibody combination, and to establish a two-parameter point map analysis template for healthy children with bone marrow cells. MRD screening was performed on 119 cases of ALL patients with newly diagnosed bone marrow cells. Was significantly different from that of normal myeloid cells as an effective immunophenotype for MRD surveillance. MRD was used to monitor the induction of end-of-treatment and consolidation of bone marrow specimens from ALL patients with these effective immunophenotype combinations. Results 119 cases of ALL children induction of chemotherapy at the end of the complete remission rate of 100%. The MRD was negative in 85 cases and recurrence in 4 cases (4.7%). MRD was positive in 34 cases and recurrence in 7 cases (20.6%). The recurrence rate of MRD-negative children was significantly different from that of positive children (P <0.05). There were 89 patients with MRD negative bone marrow before the consolidation therapy, and 2 patients (2.2%) had recurrence. Thirty patients with MRD persistent or negative to positive had recurrence, of which 9 (30.0%) had recurrence with statistical significance (P <0.01). According to the risk of disease, the patients were divided into three groups: 80 cases in standard risk group, 27 cases in intermediate risk group and 12 cases in high risk group. The MRD negative rate and positive rate in complete remission were all statistically significant among the three groups, The positive rate of MRD in risk group was significantly higher than that in standard risk group (P <0.05). Conclusion The dynamic detection of MRD by FCM can understand the curative effect and preliminarily judge the prognosis so as to adjust the treatment strategy. It is an effective method to follow-up children ALL.