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目的:探讨急性B淋巴细胞白血病(B-ALL)患者初诊与复发时白血病相关免疫表型的变化。方法:采用流式细胞术检测方法,对比分析18例B-ALL患者初诊与复发免疫表型,以复发时获得新的异常表型或丢失原有的异常表型,或异常表型荧光强度的增加或降低定义初诊与复发的免疫表型变化。结果:17例(94%)患者出现至少1个及以上异常表型的变化。10例(56%)患者出现新的异常表型,由初诊的表型阴性转为阳性;9例(50%)患者出现由阳性转为阴性的表型变化。9例(50%)患者部分阳性抗原复发时荧光强度显著增加,11例(61%)患者荧光强度显著降低,但仍表现为阳性。5例(28%)患者异常表型的获得与丢失同时存在。CD45为最稳定的标记,18例复发患者与初诊比较未发生显著变化。CD19在1例患者中初诊为阴性,复发时转为CD19阳性。可检测的抗原标记共计146个,其中发生表型变化的抗原标记占46%(67/146)。结论:复发与初诊的表型发生变化比较普遍,采用初诊的异常表型设门策略进行微小残留病灶检测可能会遗漏一些阳性患者,ALL患者微小残留病灶及复发诊断的监测应基于多个抗体组合和多个异常免疫模式的认定。
Objective: To investigate the changes of leukemia-associated immunophenotype in newly diagnosed and relapsed acute lymphoblastic leukemia (B-ALL) patients. Methods: Flow cytometry was used to compare the newly diagnosed and relapsed immunophenotypes in 18 cases of B-ALL patients, to obtain new abnormal phenotype or to lose the original abnormal phenotype or abnormal phenotype fluorescence intensity Increase or decrease the definition of newly diagnosed and relapsed immunophenotypic changes. RESULTS: At least one abnormal phenotype was observed in 17 patients (94%). Ten patients (56%) developed new abnormal phenotypes, which were changed from newly diagnosed negative to positive; in 9 (50%) patients, positive to negative phenotypic changes were observed. In 9 patients (50%), the fluorescence intensity of some positive antigens was significantly increased. The fluorescence intensity of 11 patients (61%) was significantly reduced, but still positive. In 5 patients (28%), abnormal phenotypes were acquired and lost simultaneously. CD45 is the most stable marker, 18 cases of recurrent patients compared with the first visit did not change significantly. CD19 in 1 patient newly diagnosed as negative, CD19 positive recurrence. A total of 146 antigen markers were detectable, of which 46% (67/146) were phenotypic changes. Conclusion: The phenotypes of recurrent and newly diagnosed patients are more common. The detection of minimal residual lesions using the newly diagnosed abnormal phenotype strategy may miss some positive patients. The monitoring of minimal residual disease and recurrent diagnosis of ALL patients should be based on multiple antibody combinations And the identification of multiple abnormal immune patterns.