成人急性髓系白血病患者首疗程化疗结束时微小残留病检测的临床意义  

Clinical significance of detection of minor residual disease at the end of the first course of chemotherapy in patients with adult acute myeloid leukemia

作　　者：田垚垚[1] 常玉莹[1] 董秀帅[1] 姜永芳[1] 迟佳 王京华[1] 陈曦[1] TIAN Yao-yao;CHANG Yu-ying;DONG Xiu-shuai;JIANG Yong-fang;CHI Jia;WANG Jing-hua;CHEN Xi(Department of Hematology,The Second Affiliated Hospital of Harbin Medical University,Harbin 150081,China)

机构地区：[1]哈尔滨医科大学附属第二医院血液内科,黑龙江哈尔滨150081

出　　处：《哈尔滨医科大学学报》2021年第4期390-393,共4页Journal of Harbin Medical University

基　　金：黑龙江省卫生健康委科研课题(2019-046)。

摘　　要：目的探讨成人急性髓系白血病(acute myeloid leukemia, AML)患者首疗程诱导化疗结束时检测微小残留病(minimal residual disease, MRD)的意义。方法回顾性分析2016年1月~2019年12月经过1个疗程诱导化疗后获形态学无白血病状态(morphologic leukemia-free state, MLFS)且有多参数流式细胞术MRD结果的AML患者233例,其中MRD阳性组135例,MRD阴性组98例。分析首疗程诱导化疗结束时MRD与AML患者总生存时间(overall survival, OS)、无白血病生存时间(leukemia-free survival, LFS)的关系。结果 MRD阴性组5年OS优于MRD阳性组(36.7%vs 21.5%,P=0.002)。MRD阴性组5年LFS优于MRD阳性组(37.2%vs 19.6%,P<0.001)。单因素分析表明,年龄≥60岁、初始白细胞(WBC)计数≥100×109是MRD阳性的高危因素(P均<0.05),首次诱导完全缓解(complete remission, CR)后血小板(Plt)计数≥300×109提示更高的MRD阴性率(P=0.018)。初始Plt计数、预后危险度分级在MRD阴性组和阳性组中差异均无统计学意义(P均>0.05)。结论首疗程化疗结束获MRD阴性提示更好的预后;CR后Plt计数水平与MRD阴性有一定相关性。Objective To explore the significance of detecting minor residual disease(MRD) at the end of the first course of induction therapy in adult patients with acute myeloid leukemia(AML). Methods A total of 233 AML patients with morphologic leukemia-free status(MLFS) and MRD results detected by multiparameter flow cytometry(MPFC) from January 2016 to December 2019 were retrospectively analyzed, among which 135 were in the MRD positive group and 98 were in the MRD negative group. The relationship between MRD and overall survival(OS) and leukemia-free survival(LFS) in AML patients was analyzed. Results The 5-year OS of MRD negative group was better than that of MRD positive group(36.7% vs 21.5%, P=0.002). The 5-year LFS of MRD negative group was better than that of MRD positive group(37.2% vs 19.6%, P<0.001). Univariate analysis showed that age ≥60 years old and primary white blood cell(WBC) counts ≥100×109 were the risk factors for positive MRD(P<0.05), and platelet(Plt) after the first induction of CR counts ≥300×109 indicated a higher negative MRD rate(P=0.018). However, there were no significant differences in initial Plt count and prognostic risk stratification between the positive and negative MRD groups(P>0.05). Conclusion Negative MRD at the end of the first course of chemotherapy suggests a better prognosis;Plt count level after CR was correlated with negative MRD to some extent.

关 键 词：急性髓系白血病 多参数流式细胞术 微小残留病 

分 类 号：R733.71[医药卫生—肿瘤]