流式细胞术动态监测AML完全缓解后微小残留病的临床意义  

Clinical Significance of Dynamically Monitoring Minimal Residual Disease after Complete Remission of Acute Myelocytic Leukemia by Flow Cytometry

作　　者：侯丽雪[1] 任翠爱[2] 张磊[3] 李亚茹[1] 李银柱[4] 

机构地区：[1]潍坊医学院 [2]潍坊市人民医院,山东潍坊261042 [3]石河子大学,新疆石河子832003 [4]寿光市人民医院,山东寿光262700

出　　处：《辽宁医学院学报》2014年第1期14-17,I0002,共5页Journal of Liaoning Medical University (LNMU) Bimonthly

摘　　要：目的应用流式细胞术(FCM)动态监测经诱导治疗后达完全缓解(CR)的急性髓细胞白血病(AML)微小残留病(MRD)与复发及预后的关系,探究其临床意义。方法收集2012年2月至2013年8月在潍坊市人民医院血液科确诊并达到CR的43例初诊AML(M3除外)患者,行骨髓细胞形态学检测的同时,应用FCM动态监测MRD,追踪至复发或随访结束。得出完全缓解后患者的平均微小残留水平。并同时监测CR后及巩固化疗1个疗程后2个不同时间点微小残留与复发的关系,以MRD>10-4为阳性。并对CR后MRD(+)患者中出现复发的病例数按10-4<MRD<10-3,10-3≤MRD≤10-2,MRD>10-2分为3组,观察其与形态学复发的时间关系。结果 43例CR后的患者中,测得MRD小值为0.006%,大值为4.96%,平均值为0.52%。完全缓解后MRD(+)者复发率57.14%(8/14),MRD(-)者复发率13.8%(4/29),MRD(+)者复发率高于MRD(-)者(P=0.009)。巩固治疗1个疗程后的41例骨髓标本,MRD(+)者复发率为50.0%(5/10),MRD(-)者复发率为12.9%(4/31),MRD(+)者复发率高于MRD(-)者(P=0.025)。且CR后检测MRD(+)并出现复发的8例患者均在6个月内出现了形态学的复发。结论应用FCM检测AML完全缓解后的MRD值差异较大,范围在10-5～10-2,不能作为判断完全缓解的单指标。完全缓解后及巩固治疗后MRD(+)者复发率均高于MRD(-)者,且MRD值越高,越容易早期出现复发。较常规骨髓细胞形态学检测相比,敏感性更高,可以尽早预测复发,为个体化治疗提供重要的理论依据。Objective To explore the clinical significance of applying flow cytometry （FCM） to dynamically monitor the changing trends of microscopic residual disease （MRD） in patients with acute myelogenous leukemia （AML） complete remission （CR） after in- duction therapy, and its relationship with relapse and prognosis. Method 43 newly diagnosed AML patients （except M3） were col- lected from 2012 February to 2013 August in Department of Hematology of Weifang People＇s Hospital. Bone marrow ceil morphology de- tection were given while dynamically monitoring MRD by FCM, then tracked to the relapse or the end of follow - up, and arrived at the conclusion of average level of minimal residual after complete remission. At the same time, the relationship between minimal residual and recurrence was monitored respectively after CR and after 1 course of consolidation chemotherapy, with MRD 〉 10-4positive. The recurrence cases with MRD （ ＋ ） after CR were divided into three groups according to the standardl0-4 〈 MRD 〈 10-3, 10-3≤ MRD10 -2, MRD 〉 10-2, and the relationship between time and morphological relapse was observed. Results In 43 cases after CR, the measured MRD minimum value was 0. 006%, the maximum value was 4. 96%, and the average value was 0. 52%. After complete remission, the recurrence rate of patients with MRD （ ＋ ） was 57.14% （8/14）, while the recurrence rate of patients with MRD （ - ） was 13.8% （4/29）, so the former is higler than the latter （P = 0. 009）. After one course of consolidation treatment, among 41 casesof bone marrow specimens, the recurrence rate of MRD （ ＋ ） was 50% （5/10） , whereas the recurrence rate of MRD （ - ） was 12. 9% （4/31）, so the former is higher than that the latter （ P = 0. 025）. 8 eases proved to be MRD （ ＋ ） after CR detection and morpholngle relapse appeared within 6 months. Conclusion The results of applying FCM in detecting AML after complete remission of MRD were different in he range of 10-5 - 10-2,

关 键 词：急性髓细胞白血病 完全缓解 微小残留病 流式细胞术 

分 类 号：R552[医药卫生—血液循环系统疾病]