[通过流式细胞术定期监测急性髓系白血病和急性淋巴细胞白血病患者微小残留病预测复发：一项163例单中心研究]
[Predictable recurrence by regular monitoring minimal residual disease with flow cytometry in the patients with both AML and ALL: a single-center study of 163 cases].
作者信息
Tong Chun-rong, Wang Hui, Yang Jun-fang, Lin Yue-hui, Zhang Xian, Zhao Jie, Fei Xin-hong, Gu Jiang-ying, Lu Dao-pei
机构信息
Beijing Daopei Hospital, Beijing, China.
出版信息
Zhonghua Xue Ye Xue Za Zhi. 2011 Nov;32(11):748-51.
OBJECTIVE
To study the predictable value of monitoring minimal residual disease (MRD) regularly by flow cytometry (FCM) in patients with acute leukemia (AL) in the first complete remission (CR(1)).
METHODS
From April 2005 to July 2009, AL patients who had got CR(1) after chemotherapy were regularly monitored for MRD in bone marrow by FCM to relapse or to July 2010 in Beijing Daopei Hospital (not including those received stem cell transplantation). The special antibody combinations were employed for each patient according to aberrant expression of leukemia cells. MRD(+) was defined as the aberrant cells more than 0.01%. The probability of continuous CR (CCR) was calculated by Kaplan-Meier formula, and the statistical difference between two CCR probabilities was evaluated by log-rank test.
RESULTS
A total of 163 AL patients in CR(1) were monitored to relapse or to July 2010. Among 89 AML patients referred to our hospital within 1 year after diagnosis, 30 cases were in MRD(+) and 59 cases MRD(-) till 12 months following chemotherapy, 3/30 patients in MRD(+) and 47/59 remained in CCR to July 2010. The probability of CCR at 24, 36 months was 13%, 13%in MRD(+) group, 94%, 78% in MRD(-) group respectively, the difference between them was statistically significant (P < 0.01). Among 35 ALL referred to our hospital within 5 months after diagnosis, 13 cases were MRD(+) and 22 cases MRD(-) till 5 months following chemotherapy, 0/13 patients in MRD(+) and 20/22 patients in MRD(-) remained in CCR to July 2010. The probability of CCR at 24, 36 months was 0% in MRD(+) group, 96%, 96% in MRD(-) group respectively, the difference between them was statistically significant (P < 0.01). Over the time point above, all patients with MRD(+) or their MRD from negative to positive relapsed finally, and most patients with MRD(-) remained CCR to July 2010.
CONCLUSION
It had a clinical prognostic value to monitor MRD regularly by FCM in the patients with AL after CR(1).
目的
研究流式细胞术（FCM）定期监测急性白血病（AL）患者首次完全缓解期（CR(1)）微小残留病（MRD）的预测价值。
方法
2005年4月至2009年7月，在北京道培医院对化疗后达到CR(1)的AL患者进行骨髓MRD的FCM定期监测，直至复发或2010年7月（不包括接受干细胞移植的患者）。根据白血病细胞的异常表达为每位患者采用特定的抗体组合。MRD(+)定义为异常细胞超过0.01%。采用Kaplan-Meier公式计算持续完全缓解（CCR）概率，通过对数秩检验评估两个CCR概率之间的统计学差异。
结果
共监测163例处于CR(1)的AL患者直至复发或2010年7月。在诊断后1年内转诊至我院的89例急性髓系白血病（AML）患者中，化疗后12个月时30例为MRD(+)，59例为MRD(-)，至2010年7月，MRD(+)组中3/30例患者复发，59例MRD(-)组中有47例仍处于CCR状态。MRD(+)组24、36个月时CCR概率分别为13%、13%，MRD(-)组分别为94%、78%，两组差异有统计学意义（P<0.01）。在诊断后5个月内转诊至我院的35例急性淋巴细胞白血病（ALL）患者中，化疗后5个月时13例为MRD(+)，22例为MRD(-)，至2010年7月，MRD(+)组中0/13例患者复发，MRD(-)组中20/22例患者仍处于CCR状态。MRD(+)组24、36个月时CCR概率分别为0%，MRD(-)组分别为96%、96%，两组差异有统计学意义（P<0.01）。在上述时间点之后，所有MRD(+)患者或其MRD从阴性转为阳性的患者最终均复发，大多数MRD(-)患者至2010年7月仍处于CCR状态。
结论
FCM定期监测AL患者CR(1)后的MRD具有临床预后价值。
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