摘要
目的 探讨急性淋巴细胞性白血病 (简称急淋 )缓解时和缓解期微小残留病 (MRD)的水平和变化以及与发生中枢神经系统白血病 (CNSL)的关系。方法 用改良一步煮沸法提取脑脊液DNA ,酚 /氯方法提取骨髓DNA ,巢式聚合酶链反应 (PCR)法和极限稀释定量PCR法追踪检测微小残留病 ,数据处理用Kaplan Meier方法及COX回归模型等。结果 46例急淋患儿缓解时骨髓MRD定量值与中枢神经系统白血病的发生呈正相关 (COX回归模型 ,γ =0 3496 ,P <0 0 5) ,脑脊液MRD阳性可预示发生CNSL的相对危险度 (P <0 0 5) ;缓解期脑脊液MRD持续阳性或由阴性转为阳性 ,发生中枢神经系统白血病的相对危险度明显增高 (P <0 0 5)。结论 缓解时骨髓MRD定量值和脑脊液MRD定性结果以及缓解期间脑脊液MRD的变化可以预示CNSL的危险度 。
Objective To probe into the relationship between the central nervous system leukemia (CNSL) and levels and changes of the minimal residual disease (MRD) at the time of complete remission (CR) and during CR of acute lymphoblastic leukemia (ALL).Methods A total of 46 ALL patients with entire MRD data, hospitalized from 1994 to 2000, was involved in this research The DNA of cerebrospinal fluid (CSF) was extracted by the modified one step boiling method The DNA of bone marrow (BM) was extracted by the routine phenol/chloroform method The nested polymerase chain reaction (PCR) was used for qualitative detection of MRD, in the mean time the limiting dilution assay PCR was used for the quantitative detection of MRD, in which the IgH, TCRr and TCR δ were taken as markers Kaplan Meier method, COX model and Rank test were used to analyze the data.Results The MRD levels in BM at the time of CR after induction therapy were positive correlated to the development of CNSL (COX model r =0 349 6, P =0 003 8) Among 46 cases, there were 18 cases with the positive MRD in CSF at the time of CR The opposite dangerous rate (OR) was 2 1 times higher in the positive MRD group than in the negative MRD group in CSF The analysis of survival curve showed that the 5 year disease free survival was much higher in the negative MRD group than in the positive MRD group in CSF ( P <0 05) In generally, when MRD in CSF changed from positive to negative gradually, the OR of CNSL would reduce gradually (3-18 months were 4 80-5 50 and 18-36 months 1 67) However, if the MRD in CSF was positive persistently or changed from negative to positive during the CR period, the OR of CNSL was obviously higher compared with the condition that MRD was persistently negative or changed from positive to negative Conclusion The quantitative levels of MRD in BM and the qualitatine MRD in CSF at the time of CR may predict the OR of CNSL in ALL The changes of MRD in CSF during CR period may also predict the OR of CNSL in ALL The detection of MRD was significant in predicting the prognosis and guiding the treatment in ALL
出处
《中华儿科杂志》
CAS
CSCD
北大核心
2002年第6期321-323,共3页
Chinese Journal of Pediatrics
基金
广东省卫生厅科研基金资助 (A199714 8)
