BCR-ABL阳性急性淋巴细胞白血病微小残留病的检测及其预后研究  

Study on detection and prognosis of minimal residual disease in BCR-ABL positive acute lymphoblastic leukemia

作　　者：苟阳 张诚 文钦 王平 杨武晨 邓小娟 唐永杰 杨程 彭贤贵 张曦 GOU Yang;ZHANG Cheng;WEN Qin;WANG Ping;YANG Wucheng;DENG Xiaojuan;TANG Yongjie;YANG Chen;PENG Xiangui;ZHANG Xi(Hematologic Medicine Center,Second Affiliated Hospital of Army Military Medical University,Chongqing 400037,China)

机构地区：[1]陆军军医大学第二附属医院血液病医学中心,重庆400037

出　　处：《重庆医学》2022年第1期54-59,共6页Chongqing medicine

基　　金：重庆市社会事业与民生保障科技创新专项(cstc2017shmsA130003)。

摘　　要：目的阐明BCR-ABL阳性急性淋巴细胞白血病(BCR-ABL+ALL)微小残留病(MRD)与预后的关系。方法回顾性分析2014年1月至2020年12月该院初诊的98例BCR-ABL+ALL患者的临床和实验室资料,分析MRD与移植及预后的关系。结果98例患者中移植41例(41.8%),移植患者总生存时间(OS)、无复发生存时间(RFS)均明显优于未移植者,差异均有统计学意义(P<0.05)。诱导1个疗程血液学完全缓解(CR1)时BCR-ABL下降值大于2 log的患者OS明显优于BCR-ABL下降值小于2 log者[22个月OS分别为(67.6±11.5)%、(35.1±8.1)%],二者22个月RFS比较,差异无统计学意义(P>0.05);BCR-ABL转阴患者OS、RFS均明显优于未转阴者(22个月OS分别为81.2%、8.0%;22个月RFS分别为40.7%、0),差异均有统计学意义(P<0.05)。移植前BCR-ABL转阴时移植与未移植患者OS、RFS比较,差异均无统计学意义(P>0.05);移植前BCR-ABL未转阴时移植与未移植患者OS、RFS比较,差异均有统计学意义(P<0.05);BCR-ABL下降值小于1、1~2 log时移植与未移植患者OS、RFS比较,差异均有统计学意义(P<0.05);BCR-ABL下降值大于2 log时移植与未移植患者RFS比较,差异有统计学意义(P<0.05),而OS比较,差异无统计学意义(P>0.05)。结论治疗中BCR-ABL转阴、CR1时BCR-ABL下降值大于2 log、移植是BCR-ABL+ALL患者预后的有利因素;BCR-ABL未转阴、CR1时BCR-ABL下降值小于2 log者可从移植中获益。Objective To clarify the relation between the minimal residual disease(MRD)and the prognosis of BCR-ABL positive acute lymphoblastic leukemia(ALL).Methods The clinical and laboratory data in 98 patients with BCR-ABL positive ALL initially diagnosed in this hospital from January 2014 to December 2020 were retrospectively analyzed,and the relationship between MRD with the transplantation and prognosis was analyzed.Results Among 98 cases,there were 41 cases(41.8%)of transplantation.Their overall survival time(OS)and relapse free survival time(RFS)were significantly superior to those without transplantation,and the difference was statistically significant(P<0.05).OS in the patients with the BCR-ABL decrease value>2 log in the complete remission(CR)after 1 treatment course of induction was significantly better than that in the patients with BCR-ABL decrease value<2 log[OS in 22 months:(67.6±11.5)%vs.(35.1±8.1)%],RFS in 22 months had no statistical difference between the two groups(P>0.05);OS and RFS in the patients with BCR-ABL negative conversion were significantly better than those without negative conversion(OS in 22 months:81.2%vs.8.0%;RFS in 22 months:40.7%vs.0),and the differences were statistically significant(P<0.05).OS and RFS had no statistical difference between the patients with transplantation and the patients without transplantation during BCR-ABL negative conversion(P>0.05);OS and RFS had statistical differences between the patients with transplantation and the patients without transplantation during BCR-ABL non-negative conversion(P<0.05);OS and RFS had statistical differences between the patients with transplantation and the patients without transplantation in the BCR-ABL decrease value<1,1-2 log;RFS had statistical difference between the patients with transplantation and the patients without transplantation in the BCR-ABL decrease value>2 log,while OS had statistical difference(P>0.05).Conclusion BCR-ABL negative conversion,BCR-ABL decrease value>2 log at CR1 and transplantation are the favorable f

关 键 词：白血病 淋巴细胞 急性 费城染色体 微小残留病 造血干细胞移植 异基因 酪氨酸激酶抑制剂 

分 类 号：R557.4[医药卫生—血液循环系统疾病]