多参数流式细胞术监测预处理前MRD对AML行allo-HSCT患者预后的影响

Effect of multiparameter flow cytometry for monitoring MRD before pretreatment on prognosis in patients with acute myeloid leukemia undergoing allogeneic hematopoietic stem cell transplantation

目的分析多参数流式细胞术(MFC)监测预处理前骨髓微小残留病灶(MRD)对急性髓系白血病(AML)异基因造血干细胞移植(allo-HSCT)患者预后的影响,探讨AML行allo-HSCT患者采用流式细胞术检测MRD评估预后的价值。方法回顾性分析2014年4月至2018年12月重庆医科大学干细胞移植中心收治的61例行allo-HSCT的AML患者的临床资料,其中失访3例,最后共纳入58例。预处理前骨髓采用十色MFC进行MRD检测,根据检测结果将58例患者分为MRD<1%组(39例)和MRD>1%组(19例)。结果58例AML患者中无病生存38例,总无病生存率为65.5%。移植前预处理方案、供者类型、性别并非AML行单次allo-HSCT患者无病生存期、复发和非复发死亡的影响因素。MRD是AML行单次allo-HSCT患者无病生存期、复发的影响因素。MRD<1%组患者平均总生存期[(38.99±21.54)个月]与MRD>1%组[(26.16±20.60)个月]比较,差异无统计学意义(P>0.05);平均无病生存期[(37.81±22.02)个月]明显长于MRD>1%组[(22.80±19.95)个月],差异有统计学意义(P<0.05)。结论allo-HSCT是目前可能使AML患者无病生存的有效治疗方式。预处理前MFC监测MRD是影响allo-HSCT治疗AML患者预后的因素。MRD可从骨髓形态学、免疫学、细胞遗传学、分子生物学层面进一步进行探索和总结。

Objective To analyze the effect of multiparameter flow cytometry(FCM)for monitoring the minimal residual disease(MRD)on the prognosis of the patients with acute myeloid leukemia(AML)undergoing allogeneic hematopoietic stem cell transplantation(allo-HSCT),and to investigate the value of adopting FCM for detecting MRD in the evaluation of prognosis.Methods The clinical data in 61 cases of AML undergoing allo-HSCT in the Stem Cell Transplantation Center of Chongqing Medical University from April 2014 to December 2018 were retrospectively analyzed,among them 3 cases had lose to follow up and 58 cases were finally included.MRD in bone marrow before pre-treatment was detected by using ten-color MFC.According to the detection results,these 58 cases were divided into the MRD<1%group(n=39)and MRD>1%group(n=19).Results Among 58 cases of AML,38 cases had disease-free survival(DFS)and the total DFS rate was 65.5%.The pre-treatment scheme before transplantation,donor type and sex were not the influencing factors of DFS,recurrence and non-recurrence death in the patients with AML undergoing allo-HSCT.MRD was the influencing factor of DFS time and recurrence in the patients with AML undergoing the single allo-HSCT.The average total survival period had no statistical difference between the MRD<1%group and MRD>1%group[(38.99±21.54)months vs.(26.16±20.60)months,P>0.05];the average DFS time in the MRD<1%group was significantly longer than that in the MRD>1%group,and the difference was statistically significant[(37.81±22.02)months vs.(22.80±19.95)months,P<0.05].Conclusion allo-HSCT is an effective treatment mode for the AML patients getting DFS.MFC monitoring MRD before pretreatment is a factor affecting the prognosis in the patients with AML treated by allo-HSCT.MRD can be further explored and summarized from the aspects of bone marrow morphology,immunology,cytogenetics and molecular biology.