动态监测微小残留病对B—ALL预后的临床意义

目的探讨微小残留病（MRD）监测在B急淋（B-ALL）复发预测及指导治疗中的临床意义。方法选择2008年1月到2012年7月32例初治急性B淋巴细胞白血病160份骨髓标本，利用四色多参数流式细胞术（FCM）进行微小残留病检测。以CD45／SSC设门，选择2-3组四色抗体组合，从诱导化疗第33天开始，每1—3个月监测MRD一次，动态监测MRD变化与白血病复发的关系。结果按照诱导治疗第33天的MRD水平分成三组，高（MRD〉1×10^-2），中（1×10^-2≥MRD≥1×10^-4），低（MRD〈1×10^-4）；MRD〉10^-2组与MRD％10^-4组比较复发率筹异有统计学意义（P〈0．05）；10^-4≤MRD≤10^-2组与MRD％10^-4组比较复发率差异无统计学意义（P〉0．05）。MRD％10t是预后好的指标。儿童B-ALL多次发现MRD阴性、阳性（10^-4≤MRD％10^-2）交替出现，一直未复发；B-ALL。病人复发前次MRD值均大于10^-2，且在g-6个月内复发。结论MRD阳性比形态学复发出现早，凼此连续监测MRD对白血病预测复发和指导个体化治疗有重要意义。

The clinical significance of minimal residual disease detecting in monitoring relapse of acute lymphoblastic leukemia

Objective To investigate the clinical significance of minimal residual disease（MRD） detection in acute lymphoblastic leukemia used for predicting relapse and guiding chemotherapy. Methods 160 Bone marrow aspirate was collected from 32 patients of newly diagnosed BALL from 2008.1-2012.7,Selecting 2 3 antibodies combination, MRD was detected by four-color multiparameter flow cytometry（FCM） with CD45/SSC gating from the 33th days of induction treatment ,and was done once more every one or three months . Results The MRD level of the 32 cases in the 33th day of induction treatment were devided into three groups, high group （ MRD 〉1 × 10 2） ,moderate group （ MRD be- tween 1 × 10 2and 1v 10-4） and low group （MRD〈1×10 4 ）. There was statistical significance between high group and low group（P〈0.05）. There wasn＇t statistical significance between moderate group and low group （P〈0.05）. Patients with a level of MRD〈10 4 had good prognosis. The childhood B-ALL were not found relapse when MRD were positive occasionally and MRD〈10 2. The patients were found MRD positive over 10 2 before relapse,all of them were relapsed after three or six month. Conclusion The result showed that MRD detection can predict relapse earlier than the traditional bone marrow cells morphology . So it has an important clinical significance to predict relapse and guid the individualized chemotherapy with continuous monitoring of MRD.