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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。
Objective To investigate the clinical significance of detection of minimal residual disease (MRD) in children with acute lymphoblastic leukemia (B) and to investigate the relationship between prognosis and related factors. Methods A combination of cytosolic and membrane-specific and sensitive markers was used to assess the effect of induction of chemotherapy on 67 children with B-ALL at the end of induction therapy using trichrome flow cytometry (FCM) with CD45 / SSC double- 28 ~ 37d) MRD monitoring. Results There were 18 cases in low risk group, 35 cases in intermediate risk group and 14 cases in high risk group. There was significant difference in MRD between the three groups (P <0.005) and MRD (+) rate in high risk group Lower, medium risk group (P <0.005). There was no correlation between MRD and the gender, age and white blood cell count at onset (P> 0.05). MRD in the early response to treatment there was no significant statistical difference (P> 0.05). However, MRD was closely related to recurrence and median event-free survival. The relapse rate of MRD (+) group was significantly higher than that of MRD (group) (P <0.05), and MRD (+ ) Group (P <0.005). Conclusions The detection of MRD can help to understand the curative effect and determine its prognosis so as to adjust the treatment strategy. It is an effective method to follow-up children ALL.