流式技术检测外周血白血病细胞在AML复发监测中的应用

Application of flow cytometry for detection of peripheral blood leukemic cells in monitoring of recurrence of acute myeloid leukemia

目的探讨多参数流式技术(FCM)检测外周血白血病细胞在急性髓细胞白血病(AML)复发监测中的临床应用价值。方法选择2012年1月至2014年6月我院血液科收治的56例AML患者,于首次诱导化疗结束、巩固化疗6个月、巩固化疗12个月应用FCM定期检测患者外周血标本,同时检测骨髓细胞形态学的变化。MRD≥0.01%为MRD阳性,否则为MRD阴性。AML患者首次诱导化疗结束后外周血MRD水平分为高(MRD≥10-2)、中(10-2<MRD<10-4)、低(MRD≤10-4)三个水平。采用χ2检验方法比较首次诱导化疗结束、巩固化疗6个月、巩固化疗12个月的MRD阳性组和MRD阴性组复发率差异,同时比较首次诱导化疗结束后外周血MRD高、中、低三组复发率差异。结果 FCM检测外周血MRD阳性组在首次诱导化疗结束、巩固化疗6个月、巩固化疗12个月的复发率分别为72.7%、89.3%、93.8%,MRD阴性组分别为25.0%、18.1%、0;MRD阳性组与MRD阴性组相比较,首次诱导化疗结束(χ2=7.240,P=0.007)、巩固化疗6个月(χ2=15.554,P=0.000)、巩固化疗12个月(χ2=19.562,P=0.000)三个时间点的复发率差异均有统计学意义(P<0.05);首次诱导化疗结束后外周血MRD高水平组的复发率明显高于中水平组(χ2=8.207,P=0.004)、低水平组(χ2=14.667,P=0.000),差异有统计学意义(P<0.05)。中水平组的复发率与低水平组比较差异无统计学意义(χ2=1.398,P=0.237>0.05)。结论 FCM检测外周血白血病细胞对诊断AML复发及指导个体化治疗有重要意义。

Objective To investigate the application of multi-parameter flow cytometry（FCM） for detection of peripheral blood leukemic cells in monitoring of recurrence of acute myeloid leukemia（AML）. Methods Fifty-six patients with AML from January 2012 to June 2014 in Department of Hematology in our hospital were enrolled. Peripheral blood samples of the patients were detected using FCM regularly after the first induction chemotherapy, 6months, 12 months of consolidation chemotherapy. Changes in morphology of bone marrow cell were detected.MRD≥0.01% was defined as MRD positive, and MRD〈0.01% was defined as MRD negative. MRD levels of AML patients after the first induction chemotherapy were divided into high level（MRD≥10-2）, medium level（10^-2〈MRD〈10^-4）, low level（MRD≤10^-4）. Chi square test was used to compare the recurrence rates between MRD positive group and MRD negative group after the first induction chemotherapy, 6 months, 12 months of consolidation chemotherapy.At the same time, the recurrence rates were compared between high level, medium level, low level group after the first induction chemotherapy. Results The recurrence rates after the first induction chemotherapy, 6 months, 12 months of consolidation chemotherapy were 72.7%, 89.3%, 93.8% in MRD positive group, 25%, 18.1%, 0% in MRD negative group, with statistically significant difference between the MRD positive group and MRD negative group after induction chemotherapy（χ^2=7.240, P=0.007）, 6 months of consolidation chemotherapy（χ^2=15.554, P=0.000） and 12 months of consolidation chemotherapy（ χ^2=19.562, P=0.000）, P〈0.05. After the first induction chemotherapy, the recurrence rate in MRD high level group was significantly higher than that in the medium level group（ χ^2=8.207, P=0.004） and low level group（χ^2=14.667, P=0.000）, and the difference was statistically significant（P〈0.05）. There was no statistically significant difference in the the recurrence rate between the medium level group and low level group（χ^2=1.398, P=0.237〉0.05）. Conclusion FCM detection of Leukemia cells in peripheral blood has important significance for the diagnosis of recurrent AML and guiding individual treatment.