流式细胞术动态监测微小残留病灶在急性髓系白血病中的意义

Flow Cytometry Dynamic Monitoring of Minimal Residual Lesions in Acute Myeloid Leukemia

目的:探讨急性髓系白血病(AML)在治疗过程中应用多参数流式细胞术(MFC)动态微小残留病灶(MRD)的意义。方法:选择2015年1月至2017年2月在我院血液科收治的60例AML患者,在诱导治疗第8天,第21天,每次巩固治疗前1天,结束化疗随访过程中,检测骨髓形态学变化和应用MFC监测患者骨髓MRD,并动态随访。定义未发现异常表型细胞(MRD<10^(-4))为阴性,其余为阳性。结果:平均随访时间为11个月(3到16个月),早期MRD(诱导化疗第8天)阴性的患者占58.33%,MRD阳性的患者占41.67%。MRD阴性的患者在诱导治疗接受第21天100%达到CR,MRD阳性的患者80%达到CR。第一次巩固治疗结束后,MRD阴性的患者预后明显较MRD阳性的患者好。结论:动态监测MRD对预测AML患者对治疗的反应和预测复发有重要意义。

Objective: To investigate the dynamically monitoring minimal residual disease(MRD) by multiparameter flow cytomety(MFC) in patients with acute myeloid leukemia(AML) after complete remission and its correlation with prognosis. Methods:From January 2015 to February 2017, 60 cases of patients with AML were regularly monitored for MRD in bone marrow by MFC and their bone marrow morphology was observed by light microscopy at the same time which continued to relapse or to follow-up deadline in the Department of Hematology, the First Affiliated Hospital of Haerbin Medical University. MRD <10-4 was defined as negative,otherwise, as negative. Results: Through average follow up for 11 months(3-61 months), the average MRD level of patients with CR was got. And the prognostic value of MRD level at different time points in AML patients after CR was analyzed and summarized. The results showed that maximum and minimum MRD levels of AML patients were % and 0.001%, respectively, the average was 0.99%. In most patients, MRD decreased gradually with treatment, and MRD increased and finally relapsed in 6 patients. Conclusion: Dynamic monitoring of MRD is important in predicting the response of AML patients to treatment and predicting recurrence.