Wang Li, Jiang Hui, Li Hong, Shao Jing-Bo, Lu Zheng-Hua, Yang Jing-Wei, Yang Wei-Qun
Shanghai Children's Hospital Affiliated to Shanghai Jiao Tong University, Shanghai 200040, China.
Zhonghua Xue Ye Xue Za Zhi. 2011 Jun;32(6):400-3.
To study the clinical significance of sequentially monitoring minimal residual disease (MRD) in childhood B-cell acute lymphoblastic leukemia (B-ALL).
Eighty one B-ALL cases were enrolled in the study from January 2004 to December 2009. Leukemia cell markers were detected by flow cytometry at diagnosis, then regularly followed-up.
Of 81 cases, 80 achieved complete remission (CR) after induction therapy, 5-year event-free survival (EFS) was (76.80 ± 5.70)%. Among them, the EFS was (89.40 ± 5.90)% in standard risk group and (66.99 ± 13.60)% in intermediate risk group. Eight cases were screened for leukemia markers for MRD monitoring and identified in 68; and 5-year EFS was (79.10 ± 6.20)% and (62.50 ± 15.10)% (P > 0.05, respectively). MRD detection at day 35 in induction therapy showed that 52 of 68 cases were MRD negative (leukemia cells < 0.01%), the 5-year EFS being (88.50 ± 4.90)%, and 16 were MRD positive (leukemia cells ≥ 0.01%), the 5-year EFS being (42.10 ± 20.10)% (P > 0.05). Univariate analysis confirmed that there was a correlation between MRD monitoring and risk stratification. MRD detection at day 55 showed that among the 52 day 35 MRD negative cases, 51 were still negative, 1 positive, among 16 day 35 MRD positive cases, 14 (87.50%) turned negative, 2 still positive. Of the 68 cases, 9 were MRD positive within one year after CR (3 relapsed), 4 MRD positive after one year (2 relapsed) and 55 MRD negative (4 relapsed) (P > 0.05).
Sequential monitoring MRD can find out treatment outcome and adjust therapy in time.
探讨序贯监测儿童B细胞急性淋巴细胞白血病（B-ALL）微小残留病（MRD）的临床意义。
选取2004年1月至2009年12月期间的81例B-ALL患儿作为研究对象。诊断时采用流式细胞术检测白血病细胞标志物，随后进行定期随访。
81例患儿中，80例诱导治疗后达到完全缓解（CR），5年无事件生存率（EFS）为（76.80±5.70）%。其中，低危组EFS为（89.40±5.90）%，中危组为（66.99±13.60）%。对68例患儿进行白血病标志物筛查以监测MRD，其中8例被检出；5年EFS分别为（79.10±6.20）%和（62.50±15.10）%（P>0.05）。诱导治疗第35天时MRD检测显示，68例患儿中52例MRD阴性（白血病细胞<0.01%），5年EFS为（88.50±4.90）%，16例MRD阳性（白血病细胞≥0.01%），5年EFS为（42.10±20.10）%（P>0.05）。单因素分析证实MRD监测与危险分层之间存在相关性。第55天时MRD检测显示，35天MRD阴性的52例患儿中，51例仍为阴性，1例阳性；35天MRD阳性的16例患儿中，14例（87.50%）转为阴性，2例仍为阳性。68例患儿中，9例在CR后1年内MRD阳性（3例复发），4例1年后MRD阳性（2例复发），55例MRD阴性（4例复发）（P>0.05）。
序贯监测MRD可了解治疗效果并及时调整治疗方案。
