白血病微小残留病灶VIP免费

白血病微小残留病Initial Therapy of AML Diagnosis• Complete remission (CR) must be attained to cure patient• CR defined as:—Clearance of peripheral blood & bone marrow of leukemic blasts—Reconstitution of normal hematopoiesis—Resolution of leukemic infiltratesRemissionInductionPost-remission TherapyConsolidationChemotherapySCT定义Minimal residual disease(MRD)--- 微小残留病 指白血病诱导化疗完全缓解后或者骨髓移植后残留在体内少 量白血病细胞的状态, 可能是导致白血病复发的根源白血病细胞负荷 初次诊断 --- 1012 形态学缓解 --- 1010 以下 分子学缓解 --- 约106-107Acute leukemia and CML Concept of minimal residual disease (MRD)10121010106Cell numberTimeMorphological detection limitPCR detection limitI检测MRD 的意义根据细胞负荷调整缓解后化疗方案更早发现药物耐药性更早预测白血病复发评价骨髓移植净化效果为实验研究提供依据MRD 主要检测方法一、染色体核型分析二、荧光原位杂交--- FISH三、流式细胞仪---FCM四、聚合酶链反应技术---PCR五、其他：细胞培养技术，免疫荧光等染色体核型分析常用染色体显带技术检测出染色体畸变, 但其成功率依赖于标本中分裂象细胞的数量多少，从而使得检测结果各不相同，且敏感度较低，约1 ：20 FISH fluorescence in situ hybridization 用荧光素标记染色体特异性探针和特异性基因的DNA 探针，通过与间期细胞核DNA 或中期染色体DNA 原位杂交识别染色体数目和结构的异常，可以进行定性、定位和相对定量分析 。优点：FISH 具有安全、快速、灵敏度高、探针能长期保存、能同时显示多种颜色等优点, 不但能显示中期分裂相, 还能显示于间期核. Interphase and metaphase FISH demonstrating a variant of the Philadelphia chromosome. The genes that are rearranged are: BCR(green on chromosome 22)/ABL (orange on chromosome 9)The Ph’ translocation appears as dual fusion (yellow) signals. Karyotype showing the Philadelphia chromosome.46,XX,t(9;22)(q34.1;q11.2)Figure 5: Detection of PML-RARa gene fusion by interphase FISH:Left: S-FISH (one wild type PML, one wild t...