急性髓系白血病微小残留病与疾病复发的关系

The relationship between minimal residual disease and relapse of acute myeloid leukemia

目的探讨急性髓系白血病(AML)患者诱导化疗后首次完全缓解(m CR)时,白血病微小残留病(MRD)检测的预后价值。方法回顾性分析多参数流式细胞术(MFC)监测53例AML(非M3型)MRD的百分比,研究其与疾病复发的相关性。结果复发组的MRD中位数明显高于未复发组,差异有统计学意义(P<0.05)。以0.1%为MRD的临界值,MRD阳性组与阴性组之间的复发率及3年无复发生存率(RFS)差异均有统计学意义(P<0.05)。中危核型亚组中,MRD阳性组和阴性组的复发率和3年RFS差异均有统计学意义(P<0.05)。MRD阳性组中,干细胞移植患者RFS高于化疗组;而MRD阴性组患者无论采取干细胞移植或化疗,RFS差异均无统计学意义(P>0.05)。结论 MFC检测MRD在AML诱导治疗后具有预测复发、判断预后以及指导个体化治疗的价值。

Objective To analyze the prognostic impact of minimal residual disease（ MRD） in acute myeloid leukemia（ AML）at first complete remission（ m CR） after induction therapy. Methods Retrospective analysis was applied for the monitoring of MRD percentage by multi-parameter flow cytometry（ MFC） in 53 AML（ non-APL） patients,and its correlation with the relapse free survival（ RFS） was investigated. Results The median levels of MRD in relapsed group were significantly higher than that of the non-relapsed patients,with the differences statistically significant（ P〉0. 05）. With 0. 1% as the critical value of MRD,the differences in the relapse rate and 3-year relapse-free survival（ RFS） rate were statistically significant between the positive group and negativity group of MRD（ P〈0. 05）,while the differences of that were statistically significant in the middle risk karyotype subgroup（ P〈0. 05）. Interestingly,in positive MRD group,RFS in patients with transplant was higher than that of the intensification therapy group,while in MRD negative group,the RFS differences were not statistically significant no matter there was stem cell transplantation and chemotherapy or not in patients of MRD negative group（ P〉0. 05）. Conclusion MFC monitoring MRD in AML inductive treatment has value of predicting relapse and prognosis as well as directing individualized approaches.