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目的探讨流式细胞术(FCM)检测造血干细胞移植(HSCT)后急性B淋巴细胞白血病(B-ALL)的白血病相关免疫表型(LAIP)及意义。方法采用以抗CD10/CD34/CD19/CD45为主的两组四色荧光标记抗体组合,对2005年1月至2007年1月北京大学人民医院44例急性B淋巴细胞白血病患者的133份骨髓标本进行多参数残留白血病细胞(MRD)检测。29例患者至少检测2次。结果CD45-和CD45dim是移植后B-ALL患者最常见的LAIP,占36%,其他常见的LAIP表达依次为CD34st,CD10dim,CD10st。LAIP与发病不一致或两次检测不一致的6例患者中无一例复发,与LAIP阴性组复发率差异无统计学意义,余下的LAIP阳性组复发率(5/9)明显高于LAIP阴性组的复发率(1/14)(P=0.018)。6例复发患者中5例均在复发前1~2个月内检测到LAIP。5例患者发生Ⅱ~Ⅳ度急性移植物抗宿主病,2例患者经过注射白介素-2后观察到LAIP由阳性转为阴性,1例复发患者在供者淋巴细胞输注(DLI)后获得完全缓解。结论与初诊B-ALL相似,CD45-和CD45dim是移植后最常见的LAIP。移植后LAIP阳性受到移植物抗白血病和免疫治疗的影响可以转阴。移植后早期单次LAIP阳性不一定预测复发,连续检测2次LAIP阳性表达一致对预测复发更有意义。
Objective To investigate the significance of leukemia-associated immunophenotype (LAIP) detected by flow cytometry (FCM) in acute lymphoblastic leukemia (B-ALL) after hematopoietic stem cell transplantation (HSCT). Methods A total of 133 bone marrow samples of 44 patients with acute B lymphoblastic leukemia from Peking University People’s Hospital from January 2005 to January 2007 were analyzed by using two groups of four-color fluorescent labeled antibody combination with anti-CD10 / CD34 / CD19 / Multiparameter residual leukemia cells (MRDs) were detected. 29 patients were tested at least 2 times. Results CD45- and CD45dim were the most common LAIP in B-ALL patients after transplantation, accounting for 36%. Other common LAIP expressions were CD34st, CD10dim and CD10st. No recurrence was found between LAIP and the 6 patients with inconsistent onset or inconsistent detection. The relapse rate was not significantly different from that of LAIP-negative group (5/9), which was significantly higher than that of LAIP-negative group Rate (1/14) (P = 0.018). Five of the six patients who relapsed were detected with LAIP within 1-2 months before relapse. Five patients developed grade Ⅱ-Ⅳ acute graft-versus-host disease. Two patients were found to be negative for LAIP from positive after injection of interleukin-2, and one patient who relapsed after donor-derived lymphocyte infusion (DLI) ease. Conclusions Similar to newly diagnosed B-ALL, CD45- and CD45dim are the most common LAIPs after transplantation. LAIP-positive after transplantation by graft anti-leukemia and immunotherapy can affect the negative. A single LAIP positive post-transplantation does not necessarily predict recurrence, and continuous detection of two LAIP-positive expressions is more meaningful for the prediction of recurrence.