急性淋巴细胞性白血病微小残留病变筛选指标的特点分析

目的 对儿童急性淋巴细胞性白血病微小残留病变(MRD)筛选指标进行分析并评估其意义和表达特点.方法 分离35例初发B-急性淋巴细胞性白血病(ALL)患儿的单个核细胞,对符合CD38、CD45弱表达,CD58、CD21、CD22强表达,CD34和Cu同时表达,染色体相关抗原CD66c表达的,与CD10/CD34/CD19进行四色抗体组合,应用流式仪检测,如在双参数点图上所选择的四色抗体组合出现的位置明显有别于正常骨髓相应位置的,则认定该抗体组合为有效的筛选标记并进行随后的MRD监测.结果 35例患儿中31例存在至少一个MRD标记,覆盖率为88.6%;21/35例患儿(60%)存在2个或2个以上的筛选标记;TdT/CD10/CD34/CD19为最常见的四色组合.结论 TdT/CD10/CD34/CD19作为四色MRD筛选标记覆盖率高,应作为常规和首选的筛选标记;免疫表型中Pro-B缺乏有效的筛选标记,出现2个或以上的筛选标记,对提高MRD的精确度具有重要意义.

Characteristic analysis of minimal residual disease screening markers in childhood acute lymphoblastic leukemia

Objective To analyze the screening markers of minimal residual disease (MRD) in children with acute lymphoblastic leukemia( ALL), and to evaluate its clinical application and express characteristic. Methods Thirty-five patients with childhood acute lymphoblastic leukemia treated in our hospital from 2008.11-2009.12 were enrolled into this study. Bone marrow samples were taken to isolate sing-nucleus cells. Four-color fluorochrome labeled monoclonal antibodies were applied to analyze the cell immunophenotypes when meet the demand like these: low expression of CD38, CD45; high expression of CD58,CD21, CD22; co-expression of CD34 and Cu, and the expression of abnormal chromosome related antigen CD66c. After staining of surface and intracellular antigen, sample should be detected for leukemia-associated immunophenotypes by four-color FCM with double parameters. The leukemic cell populations located in flow cytometry dot plot different from those of normal were considered to be the effective screening markers.Results Total of cases of 31 patients at least had one MRD marker, coverage is 88.6%. 21/35 (60%)had 2 or more than 2 selection markers; TdT/CD10/CD34/CD19 is the most common four-color combination, followed by CD38/CD10/CD34/CD19, CD45/CD10/CD34/CD19, other index is rare. Conclusion TdT/CD10/CD34/CD19 was the most common four-color selection markers should be as regular and preferred detection ones. Study showed the immune phenotype Pro-B is lack of effective selection markers. Two or more interest markers should be improved the accuracy of MRD significantly.