急性髓系白血病患者诱导化疗后第七或第八天微小残留病检测的预后意义

Prognostic significance of flow cytometric minimal residual disease in acute myeloid leukemia during aplasia

目的探讨急性髓系白血病（AML）患者诱导化疗后骨髓抑制期，采用多参数流式细胞术（MPFC）检测的骨髓微小残留病（MRD）在疗效判断及预后中的价值。方法回顾性分析85例初诊并于诱导化疗后第7～8天采用八色MPFC检测了骨髓MRD的AML（非急性早幼粒细胞白血病）患者临床资料，对其与疗效及预后的关系进行统计学分析。结果在85例患者中，男42例（49．4％），女43例（50．6％），中位年龄35（15～54）岁，诱导化疗后第7～8天MRD中位数0．58％（0～81．11％），1个疗程诱导治疗后完全缓解（CR）患者70例（82．4％）。根据受试者工作特征曲线（ROC曲线）得到MRD的阈值为2．305％（Se=0．867，Sp=0．800）。MRD〈2．305％的患者1个疗程CR率为96．6％（56／58），MRD≥2．305％的患者1个疗程CR率为51．9％（14／27），两组CR率差异有统计学意义（χ2=22．348，P〈0．001）；两组无复发生存率差异无统计学意义（χ2=1．08，P=0．299）；两组总生存率差异无统计学意义（χ2=0．42，P=0．516）。多因素分析结果显示，以2．305％为界的MRD（OR=21．560，95％C14．129～112．579，P〈0．001）是第1个疗程诱导疗效的唯一独立预后因素。结论AML患者诱导化疗后骨髓抑制期，采用MPFC检测骨髓MRD以2．305％为界能够预测诱导化疗疗效。

Objective To investigate the impact of minimal residual disease （MRD） by multiparameter flow cytometry（MPFC） during aplasia on efficacy and prognosis of de novo acute myeloid leukemia（AML） （non M3） patients. Methods The MRD data by 8-color MPFC during aplasia （day 14-15 of induction therapy） in 85 de novo AML（non M3） patients and the MRD impact on efficacy and prognosis were retrospectively analyzed. Results Data of 85 patients, including 42 males （49.4%） and 43 females （50.6%）, were collected, with a median age of 35 （15-54） years. The median MRD by MPFC during aplasia was 0.58% （0-81,11% ）, and 70 （82.4%） patients achieved complete remission （CR） after first induction chemotherapy. The cutoff of MRD by receiver operating characteristic （ROC） analysis was 2.305% （Se= 0.867, Sp = 0.800）. The CR rate after one course was significantly higher in patients with MRD 〈 2.305% [96.6% （56/58）] than in patients with MRD≥2.305% [51.9% （14/27） ] （χ2=22.348, P〈0.001）; no significant difference with respect to relapse-free survival rate （χ2 = 1.08, P = 0.299） or overall survival rate （χ2 = 0.42, P = 0.516） could be demonstrated for the comparison of the two groups. Multivariates analysis showed MRD divided by 2.305% was the only independent prognostic factor for CR after one course （OR = 21.560, 95% CI4.129-112.579, P〈 0.001）. Conclusion Flow cytometric MRD divided by 2.305% during aplasia could be a predictor of efficacy after first induction therapy in AML patients.