【摘要】 目的:探讨流式细胞仪(FCM)检测追踪急性白血病(AL)患者骨髓微小残留病(MRD)变化的临床意义。方法:应用FCM以白血病细胞(LC)特异分化抗原为标志监测19例初治AL患者MRD,并与传统骨髓形态学检查结果进行比较。结果:FCM检测显示共有61份标本MRD阳性,其中45份标本LC≥0.0001且<0.05,有16份标本LC≥0.05,有12份标本LC<0.0001(MRD阴性)。骨髓确诊复发的有14例,其中13例患者MRD持续阳性,于4～28个月后出现骨髓复发,比骨髓象诊断复发平均提前11个月。预测各组患者复发的敏感性和特异性分别为,完全缓解(CR)0.6～12个月组为100%(6/6)和7.7%(1/13),CR13～24个月组为100%(6/6)和28.6%(2/7),CR>25个月组为100%(2/2)和80%(4/5)。结论:利用FCM能够对AL进行MRD跟踪监测预测复发,治疗初期患者LC>0.0001,复发的危险性高,采取连续性定期监测、动态观察的方式,可以增加检测结果的准确性,对提示复发、预测预后及指导个体化治疗有重要意义。更多还原

【Abstract】 Objective To investigate the clinical significance of flow cytometry (FCM) in the detection of minimal residual disease (MRD) in patients with acute leukemia (AL). Methods MRD in 19 patients with AL were detected by FCM with idio-differentiation antigen as marker, and the results were compared with those detected by traditional bone marrow cells morphology. Results Of 73 bone mallow samples, MRD were positive in 61 samples, including 16 samples with leukemia cells ≥0.05,45 samples with leukemia cells from 0.000 1 to 0.05, and 12 samples with leukemia cells <0.0001 (MRD negative). 14 patients were diagnosed as relapse by bone marrow cells morphology, of which 13 were continually positive in MRD and were diagnosed relapse 4～28 months later (11 months before traditional bone marrow cells morphology assay). The average sensibility and specificity for predicting relapse were 100% (6/6) and 7.7% (1/13) in CR 0.6～12 months group, 100% (6/6) and 28.6% (2/7) in CR 13～24 months group, 100% (2/2) and 80% (4/5) in CR more than 25 months group, respectively. Conclusions Relapse of AL can be predicted by MRD monitor with the use of FCM. If MRD was positive in the early phase of treatment, the risk of relapse was higher. The accuracy can be increased by means of continous and regular monitor, which have important clinical significance in guiding chemotherapy, predicting relapse and selecting individualized treatment.更多还原