急性白血病异基因造血干细胞移植后流式细胞术监测微量残留病的意义  

Flow cytometric monitoring of minimal residual diseases in patients with acute leukemia after alloge-neic hemapoietic stem cell transplantation

作　　者：高雁群[1] 吴彤[1] 王卉[1] 童春容[1] 张维婕[1] 王静波[1] 卢岳[1] 赵艳丽[1] 周葭蕤 孙媛[1] 张耀臣[1] 纪树荃[1] 陆道培[2] 

机构地区：[1]北京市道培医院,100049 [2]空军总医院,100049

出　　处：《中华血液学杂志》2012年第2期84-87,共4页Chinese Journal of Hematology

摘　　要：目的研究急性白血病异基因造血干细胞移植（allo-HSCT）后采用流式细胞术（FCM）监测微量残留病（MRD）的意义。方法自2007年1月至2008年1月采用FCM对102例初诊时未检测出白血病基因和染色体改变的急性白血病allo-HSCT后患者进行骨髓MRD检测（移植后1、2、3、6、12个月，部分高危患者增加检测频率），观察MRD结果与临床转归的关系，对有意义的MRD增高患者予以临床干预并采用FCM监测疗效。MRD〉0．叭％为阳性。结果①移植后MRD持续阴性者71例，均为血液学完全缓解（CR），仅3例髓外复发，其无病生存（DFS）及总生存（0S）率分别为66．2％及90．1％。②移植后MRD阳性者27例，经过干预治疗（化疗加供者淋巴细胞输注、多种细胞因子诱导的杀伤细胞和NK细胞治疗），11例患者转阴，其DFS及0s率分别为63．6％及72．7％。另外16例血液学复发，其DFS及0s率分别为11．1％及25．0％。从MRD增高至血液学复发的中位时间为48（7-69）d。③移植后直接血液学复发者共4例，均死亡。结论移植后采用FCM检测MRD：①MRD持续阴性组患者其DFS及0s率均明显高于MRD阳性组。②移植后出现MRD阳性的患者，通过干预性治疗，MRD再次转阴后，其DFS及0s率仍然高于持续阳性组。③移植后直接血液学复发的患者，其DFS及OS率极低，预后极差。采用FCM监测急性白血病allo-HSCT后MRD是一种敏感、特异、快速、简便的方法，可及时提示复发倾向，便于早期干预治疗，降低血液学复发风险，提高allo-HSCT后患者的DFS率。Objective To study the significance of flow cytometric monitoring minimal residual dis- eases （MRD） in patients with acute leukemia （AL） after allogeneic hemapoietie stem cell transplantation （HSCT）. Methods From January 2007 and January 2008 MRD were detected by flow eytometry （FCM） in 402 bone marrow （ BM ） in 102 AL patients without leukemic gene and chromosomal changes at first diagnosis after HSCT（ 1,2,3,6,12 months after HSCT; adding detection frequency in part of high risk patients）, The relationship between the MRD results and clinical prognosis were observed. Patients with significantly higher MRD were treated and the effectiveness was monitored by FCM（ MRD 〉 0.01% considered as positive）. Re- sults ①71 cases were persistently negative for MRD after HSCT and all them were in hematologic complete remission（CR）. Only 3 cases had extramedullary relapse. The disease free survival （DFS） and overall sur- vival （OS） were 66.2% and 90.1%, respectively. ②Of 27 MRD（ ＋ ） cases 11 converted to MRD negativi- ty after chemotherapy plus donor lymphocyte infusion （ DLI）, CIK, NK cells. The DFS and OS were 63.6% and 72.7%, respectively. Other 16 cases had hematologic relapse. The DFS and OS were ll. 1% and 25.0%, respectively. The median time from MRD increasing to hematologic relapse was 48 days （ 7 - 69 day）. ③Four cases had hematologic relapse after HSCT and died in the end. Conclusions ①The DFS and the OS in MRD（ - ） cases are significantly higher than those of MRD（ ＋ ） cases. ②MRD（ ＋ ） patientsafter HSCT coveted to MRD （ - ） after intervention. Therapy, whose DFS and the OS are still significantly higher than those of MRD （ ＋ ） cases. ③Patients with hematologic relapse after HSCT have the worst progno- sis and the DFS and OS are significantly low. FCM monitoring of MRD in patients after HSCT is a sensitive, specific, quick and simple method. It can indicate recurrent state in time, facilitates early intervention, re- duces

关 键 词：流式细胞术 白血病 急性 微量残留病 造血干细胞移植 

分 类 号：R733.71[医药卫生—肿瘤]