AML化疗期间不同时间点流式细胞术MRD检测对预后的影响  

Effect of Flow Cytometric MRD Detection at Different Time Points during AML Chemotherapy on Prognosis

作　　者：居瑞雪[1] 孙凤强 王育慧[1] JU Rui-Xue;SUN Feng-Qiang;WANG Yu-Hui(Department of Clinical Laboratory Examination,Weifang People's Hospital,Weifang 261041,Shandong Province,China)

机构地区：[1]潍坊市人民医院检验科,山东潍坊261041

出　　处：《中国实验血液学杂志》2024年第4期1051-1057,共7页Journal of Experimental Hematology

基　　金：潍坊市卫生健康委员会项目(wfwsjk-2019-001)。

摘　　要：目的:探讨AML化疗期间不同时间点流式细胞术微小残留病(MRD)检测对预后的影响。方法:回顾性分析2018年3月到2022年3月确诊并规范化疗的130例成人原发AML患者,用流式细胞术检测MRD,Kaplan-Meier曲线进行生存分析,log-rank检验进行差异性分析,Cox比例风险回归模型进行影响患者生存的单因素和多因素分析。竞争风险模型进行影响患者累计复发率(CIR)的分析,Fine-Gray进行差异性分析。结果:130例患者中,CR181例,CR226例,PR 14例,NR 9例。CR1组OS高于CR2、PR、NR组。CR2组OS高于PR组,但与NR组比较无统计学差异;PR组OS与NR组比较无统计学差异。CR1和CR2的107例患者根据流式细胞术检测的MRD分组,第一次诱导化疗后MRD~-和MRD~+组患者的4年预期RFS率分别为65.3%和27.9%,4年预期OS率分别为58.7%和41.4%,4年预计CIR率分别为34.7%和69.7%,2组比较差异均有统计学意义(χ^(2)=6.639,P=0.010;χ^(2)=6.131,P=0.013;χ^(2)=6.637,P=0.010);第二次化疗后MRD~-和MRD~+组患者的4年预期RFS率分别为50.8%和37.9%,4年预期OS率分别为49.2%和44.5%,4年预计CIR率分别为49.2%和59.5%,2组比较差异均无统计学意义(χ^(2)=1.475,P=0.225;χ^(2)=2.432,P=0.119;χ^(2)=1.416,P=0.234);巩固治疗期间MRD~-和MRD~+组患者的4年预期RFS率分别为51.9%和29.6%,4年预期OS率分别为67.5%和24.6%,4年预计CIR率分别为48.1%和70.4%,2组比较差异均有统计学意义(χ^(2)=20.982,P<0.001;χ^(2)=17.794,P<0.001;χ^(2)=19.879,P<0.001);3个时间点MRD均为阴性和任一时间点为阳性患者的4年预期RFS率分别为69.9%和33.3%,4年预期OS率分别为59.1%和44.7%,4年预计CIR率分别为30.1%和65.1%,2组比较差异均有统计学意义(χ^(2)=7.367,P=0.007;χ^(2)=6.042,P=0.014;χ^(2)=7.662,P=0.006)。单因素分析结果显示,染色体高危核型是影响患者RFS和OS的不利因素,诱导化疗2个疗程达CR、第一次诱导化疗后MRD~-和第二次化疗MRD~-是患者RFS和OS的保护因素;巩固治疗期间MRD~-和Objective:To investigate the effect of flow cytometric minimal residual disease(MRD)detection at different time points during AML chemotherapy on prognosis.Methods:130 adult primary AML patients diagnosed and standardized with chemotherapy from March 2018 to March 2022 were retrospectively analyzed,MRD was detected by flow cytometry,Kaplan-Meier curves was used for survival analysis and log-rank test was used for variance analysis,and univariate and multifactor influencing patient survival with COX proportional risk regression model analysis.Cumulative incidence rate(CIR)analysis with competing risk model and variance analysis using Fine-Gray.Results:There were 81 CR1,26 CR2,14 PR,and 9 NR patients in 130 patients.OS of the CR1 group was higher than that in the CR2,PR,and NR groups.OS of the CR2 group was higher than that in the PR group,but there was no statistically difference compared to the NR group.There was no statistically difference in OS between the PR and NR groups.107patients in CR1and CR2were grouped according to MRD detected by flow cytometry,and after the first induction chemotherapy,for patients in the MRD-and MRD+groups,the4-year expected RFS rates were65.3%and27.9%respectively,the4-year expected OS rates were58.7%and41.4%respectively,and the4-year expected CIR were34.7%and69.7%respectively,with statistically significant differences between2groups(χ^(2)=6.639,P=0.010;χ^(2)=6.131,P=0.013andχ^(2)=6.637,P=0.010).After the second chemotherapy,for patients in the MRD-and MRD+groups,the4-year expected RFS rates were50.8%and37.9%respectively,the4-year expected OS rates were49.2%and44.5%respectively,and the4-year expected CIR were49.2%and59.5%respectively,with no statistically significant differences between2groups(χ^(2)=1.475,P=0.225;χ^(2)=2.432,P=0.119andχ^(2)=1.416,P=0.234).During consolidation therapy,for patients in the MRD-and MRD+groups,the4-year expected RFS rates were51.9%and29.6%respectively,the4-year expected OS rates were67.5%and24.6%respectively,and the4-year expected CIR were48.1%and70

关 键 词：急性髓系白血病 成人 化疗 微小残留病 预后 

分 类 号：R733.71[医药卫生—肿瘤]