急性髓系白血病去甲基化药物联合低剂量化疗诱导治疗2个疗程后微小残留病检测的预后预测价值  

Prognostic predictive value of detecting minimal residual disease in acute myeloid leukemia after 2 courses of hypomethylating agents combined with low-dose induction chemotherapy

作　　者：陈浩月[1] 刘春华[1] 韩乔燕[1] Chen Haoyue;Liu Chunhua;Han Qiaoyan(Department of Hematology,Jingjiang People's Hospital,Jingjiang 214500,China)

机构地区：[1]靖江市人民医院血液科,靖江214500

出　　处：《白血病．淋巴瘤》2023年第4期215-220,共6页Journal of Leukemia & Lymphoma

摘　　要：目的探讨急性髓系白血病(AML)患者去甲基化药物(HMA)联合低剂量化疗诱导治疗2个疗程后骨髓微小残留病(MRD)检测的预后预测价值。方法回顾性分析2016年1月至2021年1月靖江市人民医院收治的采用HMA联合低剂量化疗诱导治疗的43例初诊AML患者资料。患者在化疗1个疗程后及2个疗程后均采用多参数十色流式细胞术(MFC)检测骨髓MRD水平。根据MRD水平将患者分为3组:诱导化疗1个疗程后MRD转阴组(MRD-1组)、诱导化疗2个疗程后MRD转阴组(MRD-2组)以及诱导化疗2个疗程后MRD仍未转阴组(MRD+组)。比较3组间临床病理特征差异;采用Kaplan-Meier法绘制全部患者和各组患者无进展生存(PFS)和总生存(OS)曲线,比较采用log-rank检验;采用单因素和多因素Cox比例风险模型分析OS的影响因素。结果43例患者中,MRD-1组17例(39.5%),MRD-2组14例(32.6%),MRD+组12例(27.9%)。3组在性别、年龄,初诊时血红蛋白水平、白细胞计数、血小板计数、乳酸脱氢酶水平、疾病亚型、WT1表达量、染色体核型和遗传学危险度分层方面的差异均无统计学意义(均P>0.05)。中位随访15个月(1~67个月)。生存分析显示,43例患者中位OS时间21个月(95%CI 15个月至未达到),纳入PFS分析的29例患者中位PFS时间12个月(95%CI 9~18个月)。MRD-1组和MRD-2组PFS和OS均优于MRD+组(均P<0.01),MRD-1组与MRD-2组间PFS及OS差异均无统计学意义(均P>0.05);其中,MRD+组的中位PFS时间为5个月(95%CI 2个月至未达到),MRD-1组为15个月(95%CI 7个月至未达到),MRD-2组为18个月(95%CI 11个月至未达到);MRD+组的中位OS时间为9个月(95%CI 7个月至未达到),MRD-1组中位OS时间未达到,MRD-2组为38个月(95%CI 38个月至未达到)。多因素Cox回归分析显示,年龄(HR=1.080,95%CI 1.004~1.160,P=0.038)、MRD状况(MRD-1比MRD+:HR=0.125,95%CI 0.031~0.507,P=0.004;MRD-2比MRD+:HR=0.146,95%CI 0.037~0.577,P=0.006)是AML患者OS的独立影响因素。结论AML患者HMA联合�Objective To explore the prognostic predictive value of detecting minimal residual disease(MRD)after 2 courses of hypomethylating agents(HMA)combined with low-dose induction chemotherapy in patients with acute myeloid leukemia(AML).Methods The data of 43 newly diagnosed AML patients treated by HMA combined with low-dose induction chemotherapy in Jingjiang People's Hospital of Jiangsu Province from January 2016 to January 2021 were retrospectively analyzed,and the bone marrow MRD levels were detected by multiparametric 10-color flow cytometry(MFC)after 1 course and 2 courses of chemotherapy.Patients were divided into three groups according to MRD levels:the group with negative MRD after 1 course of induction chemotherapy(MRD-1 group),the group with negative MRD after 2 courses of induction chemotherapy(MRD-2 group),and the group without negative MRD after 2 courses of induction chemotherapy(MRD+group).Kaplan-Meier method was used to draw the progression-free survival(PFS)and overall survival(OS)curves of all patients and each group,and log-rank test was performed to compare them;the influencing factors for OS were analyzed using univariate and multivariate Cox proportional hazards models.Results Among the 43 patients,17 patients(39.5%)were in the MRD-1 group,14 patients(32.6%)were in the MRD-2 group,and 12 patients(27.9%)were in the MRD+group.There were no statistical differences among the 3 groups in gender,age,hemoglobin level at initial diagnosis,white blood cell count,platelet count,lactate dehydrogenase level,disease subtype,WT1 expression,karyotype,and genetic risk stratification(all P>0.05).The median follow-up was 15 months(1-67 months).Survival analysis showed a median OS time of 21 months(95%CI 15 months-not reached)in 43 patients and a median PFS time of 12 months(95%CI 9-18 months)in 29 patients included in the PFS analysis;PFS and OS in the MRD-1 and MRD-2 groups were better than those in the MRD+group(all P<0.01),and the differences in PFS and OS between the MRD-1 and MRD-2 groups were not statistica

关 键 词：白血病 髓样 急性 去甲基化 肿瘤 残余 预后 

分 类 号：R733.71[医药卫生—肿瘤]