CAJ | 학술논문

目的研究急性白血病(AL)在化疗获得第1次完全缓解( CR1)后用流式细胞术(FCM)定期监测微量残留病(MRD)的预后价值.方法对2005年4月至2009年7月北京市道培医院收治的CR1期AL患者(不包括接受造血干细胞移植者),定期用FCM监测患者骨髓MRD,追踪至复发或至2010年7月.根据每例患者的白血病特点选择抗体组合,MRD≥0.01％为阳性,否则为阴性.用Kaplan-Meier法统计持续完全缓解(CCR)率,用Log-rank检验方法比较MRD阳性与阴性患者CCR率差异.结果 163例患者中急性髓系白血病(AML) 108例,急性B淋巴细胞白血病(B-ALL)55例.89例AML患者在诊断后1年内接受MRD监测,根据化疗至12个月时的MRD检测结果将患者分为MRD阳性及阴性组:30例MRD阳性者中仅3例CCR至2010年7月,24、36个月的CCR率分别为13％、13％；59例MRD阴性者中47例CCR至2010年7月,24、36个月的CCR率分别为94％、78％；两组CCR率差异有统计学意义(P＜0.01).35例B-ALL患者在诊断后5个月内接受MRD监测,根据MRD检测结果将患者分为MRD阳性及阴性组:13例MRD阳性者无一例CCR至2010年7月,24、36个月的CCR率为0；22例MRD阴性者中20例CCR至2010年7月,24、36个月的CCR率均为96％；两组CCR率差异有统计学意义(P＜0.01).超过以上监测时间MRD阳性的其他患者均复发,而MRD持续阴性者很少复发.结论用FCM定期监测AL的MRD有良好的预后价值.
목적 연구급성백혈병(AL)재화료획득제1차완전완해( CR1)후용류식세포술(FCM)정기감측미량잔류병(MRD)적예후개치.방법 대2005년4월지2009년7월북경시도배의원수치적CR1기AL환자(불포괄접수조혈간세포이식자),정기용FCM감측환자골수MRD,추종지복발혹지2010년7월.근거매례환자적백혈병특점선택항체조합,MRD≥0.01％위양성,부칙위음성.용Kaplan-Meier법통계지속완전완해(CCR)솔,용Log-rank검험방법비교MRD양성여음성환자CCR솔차이.결과 163례환자중급성수계백혈병(AML) 108례,급성B림파세포백혈병(B-ALL)55례.89례AML환자재진단후1년내접수MRD감측,근거화료지12개월시적MRD검측결과장환자분위MRD양성급음성조:30례MRD양성자중부3례CCR지2010년7월,24、36개월적CCR솔분별위13％、13％；59례MRD음성자중47례CCR지2010년7월,24、36개월적CCR솔분별위94％、78％；량조CCR솔차이유통계학의의(P＜0.01).35례B-ALL환자재진단후5개월내접수MRD감측,근거MRD검측결과장환자분위MRD양성급음성조:13례MRD양성자무일례CCR지2010년7월,24、36개월적CCR솔위0；22례MRD음성자중20례CCR지2010년7월,24、36개월적CCR솔균위96％；량조CCR솔차이유통계학의의(P＜0.01).초과이상감측시간MRD양성적기타환자균복발,이MRD지속음성자흔소복발.결론 용FCM정기감측AL적MRD유량호적예후개치.
Objective To study the predictable value of monitoring minimal residual disease (MRD)regularly by flowcytometry (FCM) in patients with acute leukemia (AL) in the first complete remission (CR1).Methods From April 2005 to July 2009,AL patients who had got CR1 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 CR1 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 24,36months 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 chnical prognostic value to monitor MRD regularly by FCM in the patients with AL after CR1.