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目的对比ALL患儿复发及治疗失败时免疫表型的改变以及微小残留病(MRD)免疫表型与复发时免疫表型的改变。方法2000年8月-2007年12月共收治ALL患儿复发及治疗失败病例33例。复发患儿在复发前采用流式细胞术检测MRD,治疗失败患儿在诱导化疗结束后检测MRD。将复发时与治疗失败时的免疫表型与初治免疫表型进行对比;将患儿复发前MRD免疫表型与初治免疫表型进行对比,分析表面抗原表达改变的规律。结果1.B-ALL患儿27例中23例(85.18%)复发时与初治时比较,至少有1个表面抗原荧光强度改变。相对于初治免疫表型,其中6例CD45表达减弱,2例增强;CD19表达减弱2例,增强1例;CD34表达减弱6例,增强4例。CD10表达减弱5例,增强7例。2.复发/治疗失败T-ALL患儿6例均检测了CD45,相对于初治免疫表型荧光强度无变化。3.共有15例ALL患儿在复发前至少出现过1次MRD。相对于复发时的免疫表型,25次MRD中1次CD45表达增强;CD19表达减弱1次;CD34表达减弱2次,增强8次;CD10表达减弱6例,增强3例。结论ALL患儿的免疫表型在治疗失败/复发时可能发生改变,且B-ALL的改变率高于T-ALL,但改变不影响MRD的检测。
OBJECTIVE: To compare the changes of immunophenotypes, the immunophenotypes of minimal residual disease (MRD) and the immunophenotypes in relapsed and relapsed ALL patients. Methods From August 2000 to December 2007, a total of 33 children with ALL who had relapse and failure of treatment were enrolled. MRD was detected by flow cytometry before relapse in children with recurrent disease, and MRD was detected in children with failed treatment after induction chemotherapy. The immunophenotype and naive immunophenotype at the time of relapse and treatment failure were compared. The immunophenotype of MRD before relapse was compared with the naive immunophenotype, and the regularity of the change of surface antigen expression was analyzed. Results 1. In 23 cases (85.18%) of 27 children with B-ALL, the fluorescence intensity of at least one surface antigen changed at the time of recurrence. Compared with the untreated immunophenotype, the expression of CD45 decreased in 6 cases and enhanced in 2 cases. The expression of CD19 decreased in 2 cases and increased in 1 case. The expression of CD34 decreased in 6 cases and increased in 4 cases. 5 cases of weakened CD10 expression and 7 cases of enhancement. 2. Recurrent / failed treatment T-ALL children were detected in all 6 cases of CD45, relative to the initial immunophenotype fluorescence intensity no change. A total of 15 children with ALL had at least one MRD before relapse. Compared with the immunophenotype at the time of relapse, the expression of CD45 in 25 MRDs was enhanced; the expression of CD19 was decreased once; the expression of CD34 was decreased twice and increased 8 times; and the expression of CD10 decreased in 6 cases and increased in 3 cases. Conclusion The immunophenotype of children with ALL may change after treatment failure and recurrence, and the rate of B-ALL is higher than T-ALL, but the change does not affect the detection of MRD.