Liu Yong, Zhang Yifan, Hao Weidong, Liu Dai, Li Ai, Chen Chunyan
Department of Nuclear Medicine, The Second Hospital of Shandong University, Shandong, China.
Nucl Med Commun. 2008 Jun;29(6):542-5. doi: 10.1097/MNM.0b013e3282f5d2ee.
This study aimed to confirm localized residual leukaemia in the abnormal expanded peripheral bone marrow (e-PBM) of the extremities using Tc-sulfur colloid imaging and bone marrow aspirations.
Whole-body bone marrow scintigraphy was performed in 420 adult and 48 childhood leukaemia patients using Tc-sulfur colloid (370 MBq). Central bone marrow (CBM) from the iliac crest and e-PBM from the proximal epiphyseal line of the tibia were aspirated at the time of routine examination and compared.
The expansion rate of the PBM in the non-remission stage of acute leukaemia was 73.1%, and it decreased to 38.4% in the complete remission stage. The most common site of PBM expansion was the epiphysis of the knee joint (74.5%). Cytological examination of the e-PBM at the complete remission stage revealed 30.9% localized residual leukaemia. The complete remission period (69+/-23 days) of PBM expansion was significantly greater than that of CBM depletion (43+/-31 days) (P<0.01). Localized residual leukaemia of the e-PBM could not be detected in the childhood acute leukaemia patients and in the patients without e-PBM. The difference in the relapse rate and time was statistically significant between patients with e-PBM (29.1%) and without e-PBM (3.5%) (P<0.01).
These findings suggest that induction chemotherapy does not always have a synchronous and parallel effect on CBM and PBM. The e-PBM is less sensitive to chemotherapy and can easily exist in localized residual leukaemia. The detection of residual leukaemia in the e-PBM by bone marrow scintigraphy is very important in the treatment of leukaemia.
本研究旨在利用锝-硫胶体显像和骨髓穿刺来确认四肢异常扩张的外周骨髓（e-PBM）中是否存在局部残留白血病。
对420例成年白血病患者和48例儿童白血病患者进行全身骨髓闪烁显像，使用锝-硫胶体（370MBq）。在常规检查时抽取髂嵴的中央骨髓（CBM）和胫骨近端骨骺线处的e-PBM，并进行比较。
急性白血病未缓解期外周骨髓的扩张率为73.1%，完全缓解期降至38.4%。外周骨髓扩张最常见的部位是膝关节骨骺（74.5%）。完全缓解期e-PBM的细胞学检查显示30.9%存在局部残留白血病。外周骨髓扩张的完全缓解期（69±23天）显著长于中央骨髓耗竭期（43±31天）（P<0.01）。在儿童急性白血病患者和无e-PBM的患者中未检测到e-PBM的局部残留白血病。有e-PBM的患者（29.1%）和无e-PBM的患者（3.5%）的复发率和复发时间差异有统计学意义（P<0.01）。
这些发现表明诱导化疗对中央骨髓和外周骨髓并不总是具有同步和平行的作用。外周骨髓对化疗不太敏感，容易存在局部残留白血病。通过骨髓闪烁显像检测外周骨髓中的残留白血病在白血病治疗中非常重要。
