Objective To investigate the clinical significance of silver-enhanced in situ hybridization (SISH)combined with bone marrow biopsy pathology in detection of minimal residual disease (MRD)in patients with multiple myeloma(MM).Methods The bonemarrow of 36 patients with MM were detected by combined techniques including biopsy and SISH,and CD138 protein evaluated by immunohistochemistry (IHC) and κ/λ gene amplification evaluated by SISH in plasmacells.Results After the fourth and eighth course of chemotherapy,the rates of plasmacells in MM patients were 25.5% and 12.8%respectively in bonemarrowbiopsy (P<0.01).CD138 protein evaluated by IHC were ++ and +/-.κ and λ gene amplification rates were 28.3% and 7.3% respectively(P<0.01).Furthermore,the average rate of κ/λ gene amplification was 4.1%,which was significantly lower than the rate of progressive patients(13.5%) (P<0.05).The results of MRD detection showed that the higher change of κ/λ gene amplification rate,the worse curative effect,just like the change of free light chains (FLC).Conclusion The new methods of detection MRD in MM patients have many advantages,including wider visual fields and well-distributed of plasmacells in bone marrow biopsy,more intuitive and convenient observation and accurate gene signs.It is significant of this new innovative method to be widely used in assessment of curative effect and guiding chemotherapy.%目的 探讨应用银染原位杂交(SISH)技术结合骨髓病理学方法检测多发性骨髓瘤(MM)患者骨髓微小残留病灶(MRD)的临床意义.方法 对36例于该院多次住院化疗的MM患者,在第4疗程和第8疗程结束时分别取骨髓活检标本,以骨髓病理活检+免疫组织化学法测CD138,同时采用SISH法检测κ、λ基因扩增情况,以此评估MM患者的骨髓MRD.结果 36例化疗后MM患者病理活检所见浆细胞比例在第4疗程和第8疗程结束时分别为25.5%和12.8%,差异有统计学意义(P<0.01),免疫组织化学法测CD138+分别为++和+/-,SISH检测κ、λ基因扩增率分别为28.3%和7.3%,差异有统计学意义(P<0.01),说明该技术监测不同疗程MM患者的MRD差异显著.另外,在治疗有效的22例患者中,SISH测得κ、λ基因扩增水平为4.1%,显著低于进展组13.5%,差异有统计学意义(P<0.05),并呈现出疗效越差,扩增率越高的变化趋势,与血清游离轻链测定中κ/λ比值变化一致.结论 SISH技术结合骨髓病理学方法具有观察视野广、浆细胞计数稳定、基因信号准确易测等优点,对MM患者的疗效评估和治疗策略选择有临床意义.
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