多参数流式细胞术检测移植前微小残留病灶在急性白血病患者异体造血干细胞移植治疗中的意义

Clinical Significance of Minimal Residual Disease Monitoring by Multi-parameter Flow Cytometry before Allogeneic Hematopoietic Stem Cell Transplantation for Prognosis of Acute Leukemia Patients

目的:探讨异基因造血干细胞移植前多参数流式细胞术(multi-parameter flow cytometry,MFC)检测微小残留病(minimal residual disease,MRD)对于急性白血病患者预后的临床意义。方法:选取并回顾性分析2015年7月至2018年7月在重庆医科大学附一院血液内科首次进行异体造血干细胞移植(allo-HSCT)的急性白血病患者81例,其中移植前达形态学完全缓解的急性白血病患者79例,未达形态学完全缓解2例,分析完全缓解组(CR)与未完全缓解组(NCR)患者移植预后的差异,根据移植前的MRD情况分为阳性组(MRD^+)30例和阴性组(MRD^-)49例,分析MRD是否转阴与异基因造血干细胞移植术患者预后的相关性。结果:81例急性白血病患者中,CR与NCR患者3年总生存期(OS)(CR 82.2%:NCR 0%)、累计复发率(RI)(CR 17.7%:NCR 100%)、无白血病生存期(LFS)(CR 42.3%:NCR 0%),差异具有统计学意义(P<0.05)。79例患者移植前MRD^+30例(38.0%),MRD^-49例(62.0%),2组的2年OS差异有统计学差异。根据单因素分析,与MRD^-相比,MRD^+组的LFS率更低(P<0.001,95%CI 10.5%vs 36.2%)。结论:利用流式细胞术检测骨髓MRD对预测急性白血病预后具有重要的意义。与MRD^-组相比,MRD^+率无白血病生存期更短。

Objective:To investigate the clinical significance of minimal residual disease(MRD)monitoring by multiparameter flow cytometry(MFC)before allogeneic hematopoietic stem cell transplantation(allo-HSCT)in acute leukemia.Methods:81 cases of patients with AL treated with allo-HSCT in Department of Hematology,the First Affiliated Hospital of Chongqing Medical University form July 2015 to July 2018 was selected and retorspectively analyed.of which 79 patients were in CR and two patients were in non-CR.The CR group was further divided into two groups of MRD^+and MRD-based on the MRD level prior to HSCT.Results:Among 81 patients,there were statistically significant differences in the three-year overall survival(OS)(CR 82.2%:NCR 0%),cumulative relapse incidence(RI)(CR 17.7%;NCR 100%)and leukemia-free survival rate(LFS)(CR 42.3%:NCR 0%)between CR and NCR group(P<0.05).Among 79 CR patients,MRD was negative in 30 patients while positive in 49 patients,there was significant differences in the three-year overall survival between MRD-and MRD^+group.The results of univariate analysis showed that the MRD^+group showed lower LFS compared with that of MRD-group(10.5%vs 36.2%)(P<0.001,95%CI).Conclusion:MRD-patients shows longer LFS as compared with that of MRD^+patients,therefore,MRD monitoring by MFC before allo-HSCT is very important for the prognosis of the AL patients.