Objective:To evaluate the prognostic value of minimal residual disease (MRD) by flow cytometry in the diagnosis of childhood B-cell leukemia (B-ALL).Methods:196 cases of B-ALL were retrospectively analyzed from July 2011 to June 2014 in our hospital.Bone marrow MRD was measured by flow cytometry on days 15,33 and 12 weeks of induction chemotherapy.Results:The proportion of middle-risk and high-risk classification in MRD positive group was significantly higher than that in standard-risk group (P ＜ 0.05).MRD was analyzed at each time point,which showed that the higher the level of MRD,the higher the recurrence rate in children,3 years EFS lower.The MRD≥10-2 group on the 15th day,the MRD≥10-4 on the 33rd day,the MRD≥10-3 group at the 12th week had poor prognosis.MRD ≥ 10-3 on the 12th week was an independent prognostic factor by multivariate analysis.Conclusion:Flow cytometry detection of MRD in children with B-ALL has important clinical prognostic significance.Flow cytometry can be used to evaluate the therapeutic response,determine prognosis and monitor recurrence,with the need for dynamic monitoring MRD.MRD≥ 10-2 on the 15th day,MRD ≥ 10-4 on the 33rd day,poor prognosis on the 12th week of MRD ≥ 10-3,need to adjust the risk stratification and chemotherapy intensity.MRD ≥ 10-3 on the 12th week was an independent of the poor prognostic factors.%目的:探讨流式细胞术检测微小残留病(MRD)对判断儿童B淋巴细胞白血病(B-ALL)的预后价值.方法:回顾性分析2011年7月至2014年6月在我院初诊的196例B-ALL患儿,通过流式细胞术监测以上患儿诱导化疗第15天、第33天、第12周的骨髓MRD.结果:MRD阳性组中中危和高危分型的比例明显高于标危组,差异有统计学意义(P＜0.05);分析各时间点MRD,显示MRD水平越高,患儿的复发率越高,3年EFS越低.其中第15天MRD≥10-2组、第33天MRD≥10-4、第12周MRD≥10-3组的患儿预后不佳;经多因素分析显示,第12周MRD≥10-3为独立的预后不良因素.结论:流式细胞术检测MRD对儿童B-ALL具有重要的临床预后判断意义;需动态监测MRD,第15天MRD≥10-2、第33天MRD≥10-4、第12周MRD≥10-3的患儿预后不佳,需调整危险分层及化疗强度;第12周MRD≥10.为独立的预后不良因素.
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