Objectives: Central nervous system leukemia (CNSL) is one of the main causes of recurrence and death in patients with acute leukemia. This study aims to dynamically monitor minimal residual disease (MRD) in cerebrospinal fluid and bone marrow of patients with different types of acute leukemia by flow cytometry (FCM), and to compare the timeliness and consistency of MRD detection between the 2 methods to further explore the application value of monitoring MRD in cerebrospinal fluid.
Methods: A total of 199 patients with acute leukemia admitted to the Guangdong Provincial people's Hospital between October 2018 and January 2022 were retrospectively analyzed, and multiparametric FCM method was adopted to summarize and analyze MRD in cerebrospinal fluid of patients with different types of leukemia and MRD in cerebrospinal fluid and bone marrow specimens of the same patients, and its role in assessing the prognostic value of patients was discussed.
Results: Among the 199 acute leukemia cases, a total of 31 cases (15.58%) were positive MRD in the cerebrospinal fluid, of which 18 cases (58%) were detected earlier than the corresponding bone marrow specimens. Among the 19 patients with acute T lymphoblastic leukemia, 134 patients with acute B lymphoblastic leukemia, and 46 patients with acute myeloid leukemia counted, there were 4, 18, and 9 patients with positive MRD in the cerebrospinal fluid. The Kappa value of the concordance test between the results of cerebrospinal fluid MRD and bone marrow MRD in different types of acute leukemia was only 0.156, demonstrating a low concordance between them.
Conclusions: Dynamic monitoring of cerebrospinal fluid MRD by FCM can be used as a monitoring index for central nervous system leukemia, and monitoring cerebrospinal fluid can detect MRD earlier compared with bone marrow, which complements each other as a sensitive index for evaluating prognosis with significant guidance in clinic.
目的: 中枢神经系统白血病(central nervous system leukemia，CNSL)是导致急性白血病患者复发和死亡的主要原因之一。本研究旨在通过流式细胞术(flow cytometry，FCM)动态监测不同类型急性白血病患者的脑脊液和骨髓的微小残留病(minimal residual disease，MRD)，比较二者检测MRD的时效性和一致性，以进一步探讨监测脑脊液FCM在MRD的应用价值。方法: 回顾性分析2018年10月至2022年1月广东省人民医院血液科收治的199例急性白血病患者资料，采用多参数FCM，比较不同类型白血病患者脑脊液中的MRD情况以及同一患者脑脊液和骨髓标本中的MRD情况，并分析对其在评估患者预后价值中的作用。结果: 199例急性白血病患者中，脑脊液MRD阳性共31例(15.58%)，其中18例(58%)比对应骨髓标本更早检测出MRD阳性。在19例急性T淋巴细胞白血病患者、134例急性B淋巴细胞白血病患者和46例急性髓系白血病患者中，脑脊液MRD阳性的患者分别有4例、18例和9例。不同分型的急性白血病中脑脊液MRD结果与骨髓MRD结果的一致性检验Kappa值仅为0.156，表明二者一致性较低。此外，动态监测脑脊液标本可能比监测骨髓标本能更早发现体内MRD变化情况。结论: 脑脊液FCM动态监测MRD可作为CNSL的监测指标，且监测脑脊液比监测骨髓标本可能更早发现MRD，脑脊液和骨髓二者相互补充可作为评价患者预后的指标，具有一定的临床指导意义。.
Keywords: acute leukemia; cerebrospinal fluid; flow cytometry; minimal residual disease.