Homans A C, Forman E N, Barker B E
Blood. 1985 Dec;66(6):1321-5.
The identification of small numbers of leukemic cells in the cerebrospinal fluid (CSF) presents a diagnostic problem in the treatment of children with acute lymphoblastic leukemia (ALL). We adapted a latex sphere rosetting technique to allow us to identify simultaneously cell surface markers and cell morphology in 199 CSF samples from 34 patients and 14 control subjects. In patients without leukemic meningitis, the majority of CSF lymphocytes (69%) were found to be mature T cells positive for OKT11. A much smaller number of cells (8%) were found to be B cells positive for la. In these children, only 3% of CSF lymphoid cells expressed the common acute lymphoblastic leukemia antigen (CALLA). Similar results were found in the control subjects. By contrast, 28 CSF samples from nine children with varying numbers of CSF lymphoblasts had much greater proportions of CALLA- and la-positive CSF cells (24% to 96%). Leukemic meningitis was present in one of these patients and later developed in four others. However, three patients with small numbers of lymphoblasts present but with low proportions of CALLA-positive CSF cells (less than 5%) subsequently had normal CSF examinations. We found the use of this rosetting technique valuable in providing information complementary to that obtained from cell morphology alone about the possible malignant nature of small numbers of lymphoblast-like CSF cells seen on cytocentrifuge preparations in children with ALL.
在急性淋巴细胞白血病（ALL）患儿的治疗中，脑脊液（CSF）中少量白血病细胞的识别是一个诊断难题。我们采用了一种乳胶球玫瑰花结技术，以便能够同时识别34例患者和14名对照受试者的199份CSF样本中的细胞表面标志物和细胞形态。在没有白血病性脑膜炎的患者中，发现大多数CSF淋巴细胞（69%）是OKT11阳性的成熟T细胞。发现数量少得多的细胞（8%）是la阳性的B细胞。在这些儿童中，只有3%的CSF淋巴细胞表达常见的急性淋巴细胞白血病抗原（CALLA）。在对照受试者中也发现了类似的结果。相比之下，来自9名CSF原始淋巴细胞数量不同的儿童的28份CSF样本中，CALLA和la阳性的CSF细胞比例要高得多（24%至96%）。其中1例患者存在白血病性脑膜炎，另外4例后来发生了白血病性脑膜炎。然而，3例存在少量原始淋巴细胞但CALLA阳性CSF细胞比例较低（小于5%）的患者随后CSF检查结果正常。我们发现这种玫瑰花结技术有助于提供补充信息，这些信息是仅从细胞形态学获得的关于ALL患儿细胞离心涂片上所见少量原始淋巴细胞样CSF细胞可能的恶性性质的补充信息。
