急性髓细胞性白血病患者微小残留病流式细胞术检测的临床意义

 目的　探讨流式细胞术检测急性髓细胞性白血病（AML）微小残留病（MRD）的临床意义。方法　对21例生存24～128个月成年人AML完全缓解（CR）患者，采用双色直接免疫荧光标记及多参数流式细胞术每隔3～12个月检测一次外周血中MRD，同时检测骨髓细胞形态的变化。结果　21例动态检测MRD水平>10-4患者复发率为80.0 %，MRD水平≤10-4患者复发率为18.1 %。21例随访24 ~ 128个月，复发10例，其中有3例先髓外复发，未复发有11例。10例MRD水平>10-4患者24个月EFS率为30.0 %；11例MRD水平≤10-4患者为90.9 %。MRD水平≤10-4患者中复发的2例，分别在MRD水平升为10-2后3个月、7个月时出现骨髓复发。结论　MRD水平为10-3或以上的患者预后较差，易复发。MRD水平长时间波动在10-3～10-4间，即使骨髓无复发，也要警惕髓外复发。MRD水平≤10-4者生存期长，预后较好。但在生存期超过5年停化疗后，仍应动态监测MRD水平，尤其当MRD水平升至10-2水平时应警防复发，甚至考虑采用干预治疗。

The clinical significane of detecting minimal residual disease with acute myeloid leukemia by flow cytometry

Objective　Flow cytometry may be used to detect minimal residual disease(MRD) in acute myeloid leukemia(AML). The present study was designed to establish a flow cytometic method for detecting MRD in AML and evaluate its clinical prognostic value. Methods　Ｆifteen cases with AML in complete re－mission (CR) survived 24~128 months. The assary of MDR were made by using the double direct immunofluo－rescence labeling and multy-paramater flow cytometry technology. The specimens for test were peripheral blood once every 3~12 months and examined bone marrow cell morphology. Results　In 21 cases at CR, MRD levels >10-4 have 80.0 % of recurrence rate and MRD levels ≤10-4 have 18.1 %. The patients with MRD levels >10-4 at 24 months of therapy had significantly low event free survival compared with patients of MRD levels ≤10-4. Two out of eleven patients with MRD levels ≤10-4 had recurrence in the bone marrow(BM) during 3 and 7 months with MRD levels ≥ 10-2. Conclusion　Patients with MRD levels ≥10-2 had poor prognosis. The replase of extra-BM often occur at MRD levels of 10-3～10-4. Though patients with MRD levels ≤10-4 had long survival, we must detect dynamly MRD level. It is able to provide strong evidence for predict relapse and select individualized treatment in clinic.