儿童B系急性淋巴细胞性白血病微小残留病的相关因素及预后分析

Related factors and clinical significance of minimal residual disease in childhood B lineage acute lymphoblastic leukemia

摘要:

目的：了解检测儿童B系急性淋巴细胞性白血病(ALL)微小残留病(MRD)在临床上的意义,探讨其相关因素及预后的关系。方法：用一种胞浆与胞膜、特异与敏感的标志相结合,CD45/SSC双参数图设门的三色流式细胞术(FCM)对67例儿童B系ALL在诱导治疗结束时(诱导第28～37d)进行MRD监测。结果：67例随访病人低危组为18例,中危组为35例,高危组为14例,MRD在3组之间差异有显著性(P<0.005),高危组的MRD(+)率明显较低、中危组高(P<0.005)。MRD与起病时的性别、年龄、白细胞数之间无相关性(P>0.05)。MRD在早期治疗反应上也无明显的统计学差异(P>0.05)。而MRD与复发及中位无事生存期密切相关,MRD(+)组复发率明显较MRD()组高(P<0.05),MRD(+)组中位无事生存期也短于MRD()组(P<0.005)。结论：检测MRD有助于了解疗效以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。

Abstract:

OBJECTIVE: To evaluate the clinical significance of minimal residual disease (MRD) in childhood B-lineage acute lymphoblastic leukemia (B-ALL). METHODS: MRD was detected using triple-color flow cytometry (FCM) with a combination of specific and sensitive marker of cell plasma and membrance with CD45/SSC in 67 children with B-ALL at the end of the remission induction therapy. RESULTS: Of the 67 patients, 18 were low risk; 35, medium risk and 14 high risk. The MRD positive rate was significantly different among these patients with different degrees of risk. The high risk patients had the highest MRD positive rate, followed by the medium risk patients (P<0.05). MRD was not significantly correlated with the gender, age and the initial leukocyte counts, as well as with the response to early therapy. A significant association between MRD and the incidence of relapse as well as the event-free survival (EFS) period was observed. The relapse rate in patients with MRD positive was remarkably higher than that in those with MRD negative. The patients with MRD positive had a shorter EFS period compared with MRD negative patients. CONCLUSIONS: The detection of MRD can be used to evaluate the therapeutic effect and the prognosis of childhood ALL.