流式细胞术检测异基因造血干细胞移植后多形性淋巴细胞增殖性疾病——附二例报告

目的 研究流式细胞术检测在异基因造血干细胞移植(allo-HSCT)后多形性淋巴细胞增殖性疾病诊断中的作用.方法 采用多色流式细胞术诊断allo-HSCT后多形性淋巴细胞增殖性疾病.结果 2例ailo-HSCT患者分别于移植后46 d(+46 d)和+50 d出现高热,多处淋巴结肿大,抗炎治疗无效,骨髓EB病毒DNA水平升高,经流式细胞术检测发现外周血多群轻链限制性单克隆B细胞和(或)浆细胞.诊断为移植后多形性淋巴细胞增殖性疾病.经免疫抑制减量、抗病毒、使用利妥昔单抗、输细胞毒性T淋巴细胞治疗后,经流式细胞术随访监测外周血和(或)骨髓标本.2例患者的B细胞克隆均消失,但是单克隆浆细胞持续存在或者新出现的克隆.1例患者2周后死亡;另1例患者仍在治疗中,外周血未见B细胞和浆细胞,骨髓未见B细胞,可见单克隆浆细胞.结论 使用流式细胞术可以有效诊断移植后多形性淋巴细胞增殖性疾病,并进行病情监测.随访过程中,骨髓标本可能比外周血标本敏感.allo-HSCT患者如果没有淋巴结活检,通过检测外周血也可以发现B细胞异常.

Evaluation of polymorphic post-allotransplant lymphoproliferative disorder by flow cytometry

Objective To study the role of flow cytometry (FCM) in detection of polymorphic posttransplant lymphoproliferative disorders(PTLD).Methods and Results Two patients presented with fever and multiple lymphadenopathy on day 46 and day 50 respectively after successful allogeneic hematopoietic stem cell transplantation(allo-HSCT).The symptoms couldn't be controlled by antibiotics.The pelymorphic PTLD was diagnosed based on the elevation of bone marrow EB virus DNA and detection of subsets of light chain restricted B cells and/or plasma cells in peripheral blood(PB) samples.The lymphocyte immunophenotypes from PB and/or bone marrow(BM) samples were serially tested by FCM after lowering the dose of immunosupressive agents and treating with antivirus drugs,anti-CD20 antibodies,and cytotoxic T cell infusion.B cells were undetable in two patient,but monoclonal plasma cells appeared or maintained.One patient died after two weeks.Another patient was still on treatment.B cells and plasms cells couldn't be detected in her PB,but there were monoclonal plasma cells in her BM.FCM have a prominent advantage in detect polymorphic PTLD,since it can effectively recognize different cell groups in blood and identify monoclonal subsets.Besides,the immunophenotype of plasma cells in polymorphic PTLD might be different from that in typical plasma cell myeloma.Conclusion Polymorphic PTLD can be detected and followed up by FCM.BM is more suitable than PB for monitoing the disease.Besides lymph node biopsy,B cell abnormaliity could be detected in PB in allo-HSCT patients.