四色流式细胞术检测急性B淋巴细胞白血病残留细胞

目的探讨利用多参数流式细胞术检测急性B淋巴细胞白血病(BALL)残留细胞的方法和意义。方法采用四色流式细胞术,以4～6组四色抗体组合检测213例BALL患者免疫分型;以CD34、CD10、CD45、CD19为主的2种四色荧光标记抗体组合监测50例297份BALL患者骨髓标本微量残留白血病细胞,同时检测分析26份化疗后处于再生期骨髓标本中B祖细胞的免疫表型特点,并以相对定量方法比较了再生期B祖细胞与B系白血病细胞CD10、CD19和CD34表达量的差异。结果213例BALL患者中,71.8%患者存在CD45、CD34、CD19、CD10表达量的异常,只存在CD38弱阳性及髓系标志患者占8.1%。微量残留白血病细胞监测的50例患者中,12例患者存在0.06%～7.73%的白血病细胞,其中11例残留白血病细胞以CD45、CD34、CD19、CD10异常表达为主。50例患者中5例临床复发,4例在复发前7～17周微量残留病(MRD)检测阳性,且均>0.1%,1例MRD检测阴性。再生期B祖细胞依据CD45、CD34、CD19、CD10、CD22和CD20表达不同可分为3期。结论多参数流式细胞术检测MRD具有快速、敏感可定量的优势,对白血病复发有更强的预测性。

Detection of minimal residual disease in B lineage acute lymphoblastic leukemia by 4-color flow cytometry

Objective To evaluate the method and value of detecting bone marrow minimal residual disease (MRD) in B lineage acute lymphoblastic leukemia (B-ALL) by multiparameter flow cytometry(FCM). Methods The FCM immunophenotyping of B-lymphocyte precursors in regenerating stage and MRD was analyzed by using two sets of 4-color antibody panels, including mainly CD34,CD10,CD45,CD19, in 26 regenerating bone marrow samples after chemotherapy and 297 consecutive bone marrow specimens from 50 patients with B-ALL, respectively. The immunophenotype of leukemia cells of B-ALL was also detected by four to six antibodies combination of 4-color CD45/SSC gating FCM. The CD19, CD10, CD34 fluorescence intensity of B-cell precursors in normal and leukemic bone marrow was compared by relatively quantitative method. Results Twelve patients were MRD positive (MRD~+) among 50 patients during MRD monitoring, the percentages of residual leukemia cells were 0.06% to 7.73%. Eleven cases displayed CD45,CD34,CD19,CD10 antigens aberrant expression. Five patients were bone marrow relapsed and 4 of them were MRD(+) 7-17 weeks before relapse. The percentages of leukemia cells in all the 4 patients were over 0.1%. Only one patient relapsed with MRD negative. The regenerated B precursors could be divided into 3 stages according to the expression of CD45, CD34, CD19, CD10, CD22, and CD20 antigens. Abnormal expression of CD45, CD34, CD19, and CD10 were detected in 71.8% of 213 patients with B-ALL, the percentage of only aberrant expression of CD38 and myeloid antigen was 8.1%.Conclusion Detection of MRD by multiparameter flow cytometry is a rapid, quantitative and sensitive approach, and has a higher predictability for relapse.