流式细胞术监测预处理前MRD在AML异基因移植预后中的意义  

Significance of preoperative MRD detected by multiparameter flow cytometry in patients with AML undergoing allogeneic hematopoietic stem cell transplant

作　　者：薛慧 张丽蕊 王娜 陈超 谢宗源 高峰 XUE Hui;ZHANG Lirui;WANG Na;CHEN Chao;XIE Zongyuan;GAO Feng(Department of Hematology,North China University of Science and Technology Affiliated Hospital,Tangshan 063000,China)

机构地区：[1]华北理工大学附属医院血液科,河北唐山063000

出　　处：《大连医科大学学报》2023年第4期304-308,共5页Journal of Dalian Medical University

基　　金：河北省省级科技计划资助项目(22377738D);河北省医学科学研究课题计划(20210535)。

摘　　要：目的 探讨多参数流式细胞术(FCM)监测预处理前微小残留病(MRD)在急性髓系白血病(AML)外周血异基因造血干细胞移植(Allo-HSCT)预后中的意义。方法选取2018年1月至2021年6月间行AlloHSCT的41例AML患者为研究对象,均选取亲缘间供者,应用改良BU/CY±ATG清髓性方案,预处理前采用十色FCM进行MRD监测,MRD<0.1%者分至MRD阴性组(29例),MRD≥0.1%者分至MRD阳性组(12例),比较两组移植后复发、无病生存(DFS)、总生存(OS)的差异。结果随访至2022年10月,中位随访时间为38(16~58)个月,单因素分析结果显示,预处理前性别、年龄、AML分类、达CR1疗程、HLA配型均与AML移植后复发、DFS、OS无关(P>0.05);预处理前MRD水平是AML移植后复发、OS的影响因素,MRD阳性组移植后有更高复发率、更低OS率(P<0.05)。MRD阴性组和MRD阳性组移植后3年累积复发率(37.0%vs 70.0%)、OS率(62.4%vs 33.3%)比较,差异有统计学意义(P<0.05)。结论 预处理前MRD≥0.1%是AML异基因移植后复发及OS的危险因素。Objective To investigate the prognostic significance of preoperative minimal residual disease (MRD) detected by multiparameter flow cytometry monitoring (FCM) in patients with acute myeloid leukemia (AML), who underwent peripheral blood allogeneic Hematopoietic stem cell transplantation (Allo-HSCT).Methods Totally, 41 AML patients, who underwent Allo-HSCT from January 2018 to June 2021, were enrolled in the study. We selected relative donors and applied the modified BU/CY ± ATG myeloablative regimen. MRD was monitored with ten-color FCM before pretreatment. According to the monitoring results, the patients were divided into MRD negative group (n=29) if MRD<0.1% and MRD positive group (n=12) if MRD≥0.1%. The recurrence, disease-free survival (DFS), and overall survival (OS) were compared between the two groups after transplant.Results The patients were followed up until October 2022 with a median follow-up period of 38 (16-58) months. Univariate analysis revealed that gender, age, AML classification, CR1 course and HLA matching before pretreatment were not influencing factors of relapse, DFS and OS (P>0.05). MRD was the influencing factor of relapse and OS. MRD positive group had higher relapse rate and lower OS rate after transplant (P<0.05). The 3-year cumulative relapse rate (37.0% vs 70.0%) and OS rate (62.4% vs 33.3%) were significantly different between MRD negative group and MRD positive Group (P<0.05).Conclusion MRD≥0.1% by FCM monitoring before pretreatment is a risk factor for recurrence and OS in AML patients after Allo-HSCT.

关 键 词：急性白血病 多参数流式细胞术 微小残留病 异基因移植 

分 类 号：R552[医药卫生—血液循环系统疾病]