多参数流式细胞术检测急性髓系白血病微量残留病的预后意义

本研究探讨多参数流式细胞术检测急性髓系白血病（AML）微量残留病（MRD）的方法和预后意义。采用4色标记的5组抗体组合确定初治患者的白血病相关免疫表型（LAIP），选取敏感的LAIP进行追踪MRD，共检测了随访95例AML患者的601份骨髓标本。以患者LAIP阳性细胞比例高于正常值＋2倍标准差的定为MRD（＋），低于此值的为MRD（-）。结果发现：以开始诱导化疗后半年内每2个月分为3组，3组中MRD（4-）患者与MRD（-）患者之间的复发率和无复发生存率均具有显著性差异（P〈0．05），1—2个月、3—4个月和5—6个月MRD（4-）组的中位无复发生存期分别是11、11．5和11个月，MRD（-）组均未达中位生存期（P〈0．05）。进一步比较诱导缓解后与巩固治疗1个疗程后患者MRD检测结果与临床的关系，发现这两个时间点MRD（＋）组和MRD（-）组的患者复发率分别为57．14％与0％和91．67％与2．27％（P=0．000和P=0．000）。结论：多参数FCM检测MRD能够有效预测复发，治疗后应连续进行MRD检测。

Prognostic Significance of Minimal Residual Disease Detected by Multiparameter Flow Cytometry in Acute Myeloid Leukemia

This study was aimed to explore prognostic significance of minimal residual disease （MRD） detection in patients with acute myeloid leukemia （AML） by multiparameter flow cytometry （MCF）. Leukemia-associated immunophenotype （LAIP） of newly diagnosed AML patients were determined by 4-color 5 antibody panels and patients with sensitive LAIP were chosen for MRD detection. 601 bone marrow samples from 95 patients were acquired after treatment and MRD were considered positive by the critical normal value plus twice standard deviation in normal bone marrow specimen. The patients were divided into three groups and the clinical significance was analyzed every 2 months within initial 6 months after induction treatment. The results showed that the relapse rate and relapse-free survival （ RFS ） rate were all significantly different between MRD positive and MRD negative patients in the three groups （p 〈 0.05）. Patients with MRD positive had a median relapse-free survival time of 11 months, 11.5 months and 11 months at 1 - 2, 3 - 4 and 5 - 6 months respectively, while all patients with MRD negative were not observed to reach median relase-free survival time （ p 〈 0. 05 ）. Furthermore, the clinical significance was analyzed after induction and one course of consolidatory treatment, the relapse rate of MRD positive and MRD negative patients were 57. 14% versus 0% and 91.67% versus 2.27% respectively （p =0. 000 and p =0. 000）. It is concluded that MRD detection by multi-parameter flow cytometry can predict outcome of AML patients, which should be continuously monitored after treatment.