FLT3基因动态监测在急性髓系白血病治疗中的应用

Dynamic Detection of FLT3 Gene in Patients with AML and Its Significance

微小残留病(Minute Residual Disease,MRD)是急性髓系白血病(Acute myeloid leukaemia,AML)复发和妨碍长期无病生存率的重要原因。本研究旨在探讨FLT3基因在AML发病中的作用及对微小残留病(MRD)检测的意义。应用PCR技术检测了125例AML患者在化疗与异基因造血干细胞移植(allo-HSCT)治疗前后FLT3基因的表达,并对FLT3基因阳性者进行了随访观察。结果表明:PCR检测FLT3基因的灵敏度为10-4;AML初诊患者中FLT3基因的阳性表达率为69.6%;完全缓解(CR)患者FLT3表达基因阳性表达率44.90%,FLT3转为阴性者占48.98%;FLT3表达无改变者占6.12%;复发者FLT3基因表达转为阳性,而未缓解者FLT3持续阳性,治疗前FLT3阳性AML患者完全缓解率低于FLT3基因表达阴性患者,两者有显著性差异(p<0.05)。获得CR的FLT3阳性AML患者的复发率显著高于FLT3阴性患者(p<0.05)。结论:FLT3基因表达与白血病发生有关,PCR动态检测AML患者治疗前后FLT3表达水平,可作为判断AML白血病预后和监测微量残留病的一项指标。

Minimal residual disease （MRD） is an important cause of relapse and disease-free survival time decrease in patients with acute myeloid leukemia （AML）. This study was aimed to explore the role of FLT3 gene in AML pathogenesis and its significanse for detection of MRD. Using genomic PCR, 125 AML patients were detected for FLT3 gene expression before and after chemical therapy and allogeneic hematopoietic stem cell transplantation （allo-HSCT）, meantime the AML patients with FLT3 positive expression were observed by follow-up. The results showed that the sensitivity of PCR was 10^-4 in FLT3 gene detection; the rates of FLT3 positive expression were 69.6% and 44.90% in the newly diagnosed AML patients and complete remission （CR） patients respectively. The rate of FLT3 expression coverted to negative was 48.98% in treated AML patients, while no change of FLT 3 expression was found in 6. 12% treated patients. The FLT3 expression converted to positive in relapsed patients, and FLT3 expression remains positive in non-remitted patients. The CR rate in FLT3 positive expression patients before treatment was significantly lower than that in FLT3 negative expression patients, the difference of which was statistically significant （p 〈 0.05 ）. The AML relapse rate in FLT3 positive patients was significantly higher than that in FLT3 negative expression patients （ p 〈 0.05 ）. It is concluded that FLT3 gene expression is related to leukemia pathogenesis ; the dynamic levels of FLT3 expression before and after treatment can be used for estimating prognosis of AML patients and detecting MRD.