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目的探讨流式细胞仪(FCM)检测追踪多发性骨髓瘤(MM)患者骨髓微小残留病灶(MRD)变化的临床预后应用。方法应用FCM以骨髓瘤细胞(MC)特异分化抗原为标志检测48例初治MM患者MRD,并与传统骨髓形态学检查结果进行比较。结果FCM检测显示124份标本中共有108份标本MRD阳性,其中21份标本MC≥0.05,有87份标本MC≥0.0001且<0.05,有16份标本MC<0.0001(MRD阴性),其中骨髓确诊复发的有10例,其中7例患者MRD持续阳性于4～28个月后出现骨髓复发,比骨髓象诊断复发平均提前10个月,预测各组患者复发的敏感性均为100%,特异性分别为完全缓解(CR)1～12个月组为22.2%(2/9),CR13～24个月组为66.6%(2/9),CR>25个月组为66.6%(2/3),差异有统计学意义(χ2=13.47,P<0.05)。结论利用FCM能够对MM进行MRD监测预测复发,治疗初期患者MC>0.0001,复发的危险性高,连续定期动态观察对提示复发、预测预后及指导个体化治疗有重要意义。
Objective To investigate the clinical prognosis of bone marrow micrometastasis (MRD) in patients with multiple myeloma (MM) by flow cytometry (FCM). Methods FCM was used to detect MRD in 48 cases of newly diagnosed MM patients with myeloma cell (MC) specific differentiation antigen and compared with the results of conventional bone marrow biopsy. Results FCM showed that there were 108 specimens of MRD positive in 124 specimens, of which 21 specimens were MC≥0.05, 87 specimens were MC≥0.0001 and <0.05, and 16 specimens were MC <0.0001 (MRD negative) Of the 10 cases, of which 7 cases of patients with MRD persistent positive in 4 to 28 months after bone marrow recurrence than the diagnosis of bone marrow recurrence average 10 months in advance, predict the recurrence of each group were 100% sensitivity, specificity, respectively The rate of complete remission (CR) was 22.2% (2/9) in 1-12 month group, 66.6% (2/9) in CR13-24 month group and 66.6% (2/3) in CR> 25 month group , The difference was statistically significant (χ2 = 13.47, P <0.05). Conclusion The use of FCM can predict the recurrence of MM by MRD. The initial treatment of patients with MC> 0.0001, the risk of recurrence is high. Continuous dynamic observation is of great significance to prompt relapse, prognosis and individualized treatment.