Clinical Significance Of Determination Of Minimal Disease Based On GD2 Immunocytology In High-risk Neuroblastoma

Objective To compare the sensitivity of bone marrow smear and GD2 staining in the determination of NB minimal disease,and explore the predictive effect of GD2-based immunocytology on the prognosis of children with NB,Meanwhile,to analyze the effect of stem cell transplantation on prognosis of children with high-risk NB.Methods The clinical and pathological data of 56 patients with high-risk neuroblastoma from Tianjin Medical University Cancer Hospital from February 2011 to September 2018 were retrospectively analyzed.The clinical significance of the determination of minimal disease based on GD2 immunocytology in children with high-risk NB is discussed from the following aspects:1.Comparative study on sensitivity of determination of minimal disease:sensitivity differences of NB minimal disease detected by bone marrow smear method and GD2-based immunocytography at the time of diagnosis and the end of chemotherapy were analyzed.2.Correlation analysis between GD2 positive and clinicopathological factors at diagnosis: Pathological factors such as gender,age,tumor site,abnormal amplification of MYCN gene and initial NSE level were further studied.In addition,overall survival(OS)and disease-free survival(DFS)of children with initial GD2 positive and negative in bone marrow were compared and analyzed.3.Study on the correlation between the expression of GD2 in the bone marrow at various treatment stage and the recurrence and prognosis: statistical methods were used to analyze the correlation between bone marrow GD2 expression and recurrence and poor prognosis in children with NB at various treatment stages.4.Efficacy analysis of stem cell transplantation: To analyze the effect of stem cell transplantation on the prognosis of high-risk NB children,and divide the children into GD2 positive and negative groups.Then to explore the efficacy of stem cell transplantation within these groups,respectively.Results1.Comparative study on sensitivity of determination of minimal disease: The differences in sensitivity of bone marrow smear and GD2 staining were statistically significant at the time of diagnosis and the end of chemotherapy.2.Correlation analysis between GD2 positive and clinicopathological factors at diagnosis: There was no significant difference in gender,age,tumor site,abnormal amplification of MYCN gene and initial NSE level between children with GD2 positive and negative in bone marrow at the time of diagnosis(P >0.05).The differences of OS and DFS compared between the two groups were also not statistically significant(P > 0.05).3.Study on the correlation between the expression of GD2 in the bone marrow at various treatment stage and the recurrence and prognosis: At the time of diagnosis and after 2 courses chemotherapy,GD2 positive had no effect on the recurrence and overall survival.However,GD2 was still positive after 4courses chemotherapy and at the end of chemotherapy,which is a risk factor for recurrence and poor prognosis.4.Efficacy analysis of stem cell transplantation: The difference was statistically significant in the effect of stem cell transplantation on the prognosis of children with high-risk NB,and the recurrence rate showed a downward trend after stem cell transplantation.Conclusion The determination of minimal disease based on GD2 immunocytology is more sensitive than bone marrow smear.At the time of diagnosis and after 2 courses chemotherapy,the expression of GD2 isn't related to the prognosis of children with high-risk NB,but the GD2 staining is still positive after 4 courses chemotherapy,indicating poor prognosis and prone to recurrence.hematopoietic stem cell transplantation can reduce the recurrence rate and mortality,which is more obvious for children with GD2 positive at the end of chemotherapy.