Lv Jun-Ting, Yang Zhi-Gang, Guang You-Hong, Lin Zhong-Shun, Xiao Xing-Xian, Liu De, Shi Man, Wang Wen-Shan
Department of Hematology, Central Hospital of Jiangmen City, Jiangmen 529000, Guangdong Province, China.
Department of Hematology, The Affiliated Hospital of Guangdong Medical University, Jiangmen 529000, Guangdong Province, China. E-mail:
Zhongguo Shi Yan Xue Ye Xue Za Zhi. 2018 Jun;26(3):658-664. doi: 10.7534/j.issn.1009-2137.2018.03.005.
To investigate the presence of leukemia stem cells (LSC) in acute myeloid leukemia (AML) and find out the relative position of leukemia cells in the figures of flow cytometry, and to analyze the relationship between minimal residual diseases (MRD) and the level of LSC, so as to explore the correlation of LSC changes with the curative effect and the prognosis during chemical therapy.
A total of 85 samples were collected from 50 AML (except M3) patients, including 50 samples from the newly diagnosed patients, 7 samples of AML patients with non-remission and 28 samples of AML patients with complete remission. All samples were used for detection of LSC from immune phenotype of CD34/CD38/CD123 by flow cytometry. The detection of immune phenotypic of leukemia cells was performed in the newly diagnosed patients. The detection of leukemia- associated immune phenotypes (LAIP) was implemented in the non-newly diagnosed patients.
The LSC was identified in the CD34/ CD38/ CD123 in AML and consistent with the relative position of the leukemia cell in flow cytometry figures. Statistical analysis showed significant difference in LSC content between the newly diagnosed AML group and the post-chemotherapy complete remission group(P<0.01),but did not between the newly diagnosed AML group and the post-chemotherapy non-remission group(P>0.05).There was significant positive correlation between the LSC content and MRD level in 28 AML patients with complete remission (r=0.680,P<0.01).
LSC exist in AML and the relative position are consistent with the leukemia cells in flow cytometry figures, the size characteristics and weak expression of CD45 are also similar to leukemia cells. The proportion of LSC decreases after chemotherapy. Detecting and tracking the LSC changes in bone marrow and combination with detecting minimal resident disease(MRD) may contribute to evaluate the theraputic efficacy and prognosis of leukemia patients.
探讨急性髓系白血病（AML）中白血病干细胞（LSC）的存在情况，明确白血病细胞在流式细胞术图中的相对位置，分析微小残留病（MRD）与LSC水平的关系，以探究LSC变化与化疗疗效及预后的相关性。
收集50例AML（M3除外）患者的85份样本，其中初诊患者50份样本，未缓解的AML患者7份样本，完全缓解的AML患者28份样本。所有样本采用流式细胞术从CD34/CD38/CD123免疫表型检测LSC。初诊患者检测白血病细胞的免疫表型，非初诊患者检测白血病相关免疫表型（LAIP）。
在AML的CD34/CD38/CD123中鉴定出LSC，且与流式细胞术图中白血病细胞的相对位置一致。统计分析显示，初诊AML组与化疗后完全缓解组的LSC含量有显著差异（P<0.01），而初诊AML组与化疗后未缓解组之间无显著差异（P>0.05）。28例完全缓解的AML患者中，LSC含量与MRD水平呈显著正相关（r=0.680，P<0.01）。
AML中存在LSC，其相对位置与流式细胞术图中的白血病细胞一致，CD45的大小特征及弱表达也与白血病细胞相似。化疗后LSC比例降低。检测和追踪骨髓中LSC的变化并结合检测微小残留病（MRD）可能有助于评估白血病患者的治疗效果和预后。
