流式微小残留病检测在急性髓系白血病化疗后疗效评估中的价值

The value of flow minimal residual detection in evaluating the efficacy of chemotherapy in patients with acute myeloid leukemia

目的探讨流式微小残留病(MRD)检测在急性髓系白血病(AML)化疗后疗效评估中的价值。方法收集128例AML为研究对象,评价首次化疗后MRD水平分别与细胞形态学缓解度、细胞遗传学的相关性分布;96例AML-CR患者依据MRD水平分组,评价1年期复发率。结果 128例AML患者经首次化疗后,75.00%(96/128)显示完全缓解(CR),25.00%(32/128)显示部分缓解(PR)或未缓解(NR)。96例CR中,MRD阴性占67.71%(65/96),MRD阳性占32.29%(31/96)。MRD水平与细胞遗传学相关性评价中,细胞遗传学预后较好组、预后中等组、预后较差组的MRD阴性率分别为59.52%、49.25%、36.84%,3组差异无统计学意义(χ~2=2.824,P>0.05)。MRD阳性组复发率明显高于MRD阴性组,差异有统计学意义(χ~2=14.997,P<0.05)。结论 MRD监测对指导AML治疗及早期预测复发具有重要的临床意义。

Objective To evaluate the value of flow minimal residual detection in evaluating the efficacy of chemotherapy in patients with acute myeloid leukemia（ AML）. Methods A total of 128 patients with AML were selected as the research object;the correlation of the level of MRD with the degree of cellular morphological remission and cytogenetics was evaluated; 96 patients with AML-CR were evaluated according to the MRD level to evaluate the one-year recurrence rate. Results In 128 patients with AML,75. 00%（ 96/128） showed complete remission（ CR） after initial chemotherapy,and 25. 00%（ 32/128）showed partial remission（ PR） or no remission（ NR）. 96 patients with CR,the negative rate of MRD was 67. 71%（ 65/96）,and the positive rate of MRD was 32. 29%（ 31/96）. In the degree of cellular morphological remission cell evaluation,the negative rates of MRD of the better prognosis of cytogenetics group,the moderate prognosis group and the poor prognosis group were59. 52%,49. 25% and 36. 84%,respectively. The difference among the three groups was not statistically significant（ χ^2=2. 824,P〉0. 05）. In 96 patients with AML-CR,according to different levels of MRD,the recurrence rate of positive MRD group was significantly higher than that of the negative MRD group,and the difference was statistically significant（ χ^2= 14. 997,P〈0. 05）. Conclusion MRD monitoring has important clinical significance in guiding AML therapy and early prediction of recurrence.