流式细胞术检测微小残留病变在急性白血病造血干细胞移植中的应用

目的探讨流式细胞术（FCM）检测微小残留病变（MRD）在急性白血病（AL）造血干细胞移植（HSCT）中的应用。方法采用以CD45与侧向散射光（CD45/SSC）设门的三色及四色荧光标记流式细胞术检测114例AL患者移植前后的MRD水平,回顾性分析MRD与预后的关系。结果移植前MRD高于10-4尤其是高于10-3者和移植后MRD持续高于10-3者移植后复发率明显增高,移植前MRD高于10-3者其无事件生存率和无复发生存率明显低下（均P〈0.05）。首次检出MRD高于10-3的时间比临床诊断复发提前3个月。结论采用FCM动态监测AL患者HSCT前后的MRD水平,可有效评估患者预后,从而指导临床早期干预性治疗,降低移植后复发率。

Application of Flow Cytometry in Detection of Minimal Residual Disease in Hematopoietic Stem Cell Transplantation for Patients with Acute Leukemia

Objective To explore the relation between the outcome of patients with acute leukemia（AL） and the level of minimal residual disease by flow cytometry（FCM） in hematopoietic stem cell transplantation（HSCT）.Method With the use of three or four-color FCM（CD45/SSC gating） to detect minimal residual disease（MRD）,we retrospectively analyzed the MRD levels and prognosis of one hundred and fourteen AL patients before and after HSCT.Results Patients whose MRD levels were 10 -4 especially 10 -3 pre-HSCT and continuously 10 -3 post-HSCT had higher incidence of relapse.Patients with MRD levels 10 -3 pre-HSCT presented higher relapse rate and lower three-years event-free survival,relapse-free survival（all P 0.05）.The median time from high level MRD detected 10 -3 first time to clinical relapse was 3 months.Patients with MRD more than 10 -3 detected successively preand post-HSCT took more chance to relapse than other groups.Conclusion This study indicates that MRD should be detected dynamically with FCM,both pre-and post-HSCT,for patients with AL undergoing HSCT to provide information for clinical intervention therapy in order to reduce the relapse rate.