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目的研究监测微小残留白血病(MRD)在B系急性淋巴细胞白血病(ALL)患儿治疗中的作用。方法回顾性研究了2001年9月1日至2005年4月31日,采用ALL-XH-99方案治疗的B系ALL患儿中进行MRD监测的患儿共124例。用四色多参数流式细胞仪监测ALL患儿治疗过程中不同时间点的MRD。结果在124例进行过MRD监测的B系ALL患儿中,其中MRD<0.01%、0.01%～0.1%和>0.1%的分别有103例、13例和8例,其5年无复发生存率(RFS)分别为(88.9±3.9)%、(70.0±14.5)%和0%,而5年无事生存率(EFS)分别为(82.4±4.4)%、(21.2±18.0)%和0%,两者均P<0.01;将首次CR后半年内MRD检查分成阴性(<0.01%)和阳性两组,其5年RFS分别为(87.7±4.1)%和(58.3±14.2)%,(P<0.01);5年EFS分别为(80.7±4.6)%和(25.6±13.8)%(P<0.01);首次CR后半年以后MRD检查阴性和阳性两组的5年RFS分别为(92.0±3.6)%和(48.5±15.5)%(P<0.01)。多因素分析显示结果显示诱导缓解后MRD、泼尼松诱导窗口反应、第19天骨髓象是否达M-1级骨髓象和是否检出BCR-ABL或MLL-AF4融合基因对患儿治疗过程中是否发生复发有预后价值(P<0.05)。结论在B系ALL患儿治疗过程中,无论在诱导缓解达到CR时,还是在随后的治疗过程中,监测MRD水平对于评估ALL患儿疗效有重要意义。
Objective To investigate the role of monitoring minimal residual leukemia (MRD) in the treatment of children with B-lineage acute lymphoblastic leukemia (ALL). Methods A retrospective study of 124 children with B-lineage ALL who were treated with the ALL-XH-99 regimen from September 1, 2001 to April 31, 2005 was performed. Four-color multi-parameter flow cytometry was used to monitor MRD at different time points during the treatment of ALL children. Results Of 124 children with B-lineage ALL who had MRD monitoring, 103 had MRD <0.01%, 0.01% -0.1%, and> 0.1%, respectively, and 13 had a history of 5 years and 8 had no recurrence (RFS) were (88.9 ± 3.9)%, (70.0 ± 14.5)% and 0%, respectively. The 5-year EFS were 82.4 ± 4.4%, 21.2 ± 18.0% and 0% (P <0.01). The 5-year RFS was (87.7 ± 4.1)% and (58.3 ± 14.2)%, respectively, in the first 6 months after the first CR (P <0.01). The five-year EFS were (80.7 ± 4.6)% and (25.6 ± 13.8)% respectively (P <0.01). The 5-year RFS of the negative and positive MRD patients after the first CR were 92.0 ± 3.6 )% And (48.5 ± 15.5)% (P <0.01). Multivariate analysis showed that MRD and prednisone-induced window responses were induced after induction of remission. On the 19th day, whether bone marrow was up to M-1 bone marrow and whether BCR-ABL or MLL-AF4 fusion gene was detected in the treatment of children Whether recurrence has a prognostic value (P <0.05). Conclusions In the treatment of children with B-ALL, the monitoring of MRD level is of great significance in assessing the curative effect of ALL children both when CR is induced or when CR is treated.