中华医学杂志
中華醫學雜誌
중화의학잡지
National Medical Journal of China
2011年
38期
2692-2696
,共5页
施晓兰%唐晓文%魏孝艾%赵丙瑞%周倩兰%叶凡%路钰夏%孙兴卫%朱明清%沈文红%仇惠英%孙爱宁%吴德沛
施曉蘭%唐曉文%魏孝艾%趙丙瑞%週倩蘭%葉凡%路鈺夏%孫興衛%硃明清%瀋文紅%仇惠英%孫愛寧%吳德沛
시효란%당효문%위효애%조병서%주천란%협범%로옥하%손흥위%주명청%침문홍%구혜영%손애저%오덕패
白血病%造血干细胞移植%微小残留病变%高危%流式细胞术
白血病%造血榦細胞移植%微小殘留病變%高危%流式細胞術
백혈병%조혈간세포이식%미소잔류병변%고위%류식세포술
Leukemia%Hematopoietic stem cell transplantation%Minimal residual disease%High risk%Flow cytometry
目的 分析急性白血病(AL)高危患者异基因造血干细胞移植(allo-HSCT)前后微小残留病变(MRD)水平与移植后预后的关系.方法 采用以CD45/SS设门的4色或5色荧光标记多参数流式细胞术(MFC)动态检测90例高危AL患者allo-HSCT前第30天、移植后第30、60、100天和6、9、12个月的MRD水平,以0.1％为界,将患者分为MRD高水平组(≥0.1％)和低水平组(＜0.1％),其中高水平组根据移植后是否干预治疗分为两组,回顾性分析MRD水平与预后的关系.结果 移植前MRD水平与移植后预后无明显关系,移植后第60、100天MRD高水平组患者移植后复发率明显高于低水平组.移植后第100天,MRD高水平干预组、MRD高水平未干预组、MRD低水平组1年无复发生存率(RFS)分别为100％、60.87％和91.30％,3年RFS分别为85.71％、44.72％和68.48％,组间差异均有统计学意义(均P＜0.05).复发患者首次检出MRD高水平的时间比临床诊断复发提前了2.5(1.0 ～26.0)个月.移植后第100天,30例MRD高水平组患者中,7例患者及时接受干预治疗后均未复发,而另外23例未接受干预治疗的患者中11例出现复发(P＜0.05).结论 多参数流式细胞术动态监测高危AL患者移植后MRD可以有效评估其临床预后,并可根据移植后第100天MRD进行危险分层,MRD≥0.1％的患者预后较差,及时进行有效的干预可以明显降低其复发率,增加长期生存率.
目的 分析急性白血病(AL)高危患者異基因造血榦細胞移植(allo-HSCT)前後微小殘留病變(MRD)水平與移植後預後的關繫.方法 採用以CD45/SS設門的4色或5色熒光標記多參數流式細胞術(MFC)動態檢測90例高危AL患者allo-HSCT前第30天、移植後第30、60、100天和6、9、12箇月的MRD水平,以0.1％為界,將患者分為MRD高水平組(≥0.1％)和低水平組(＜0.1％),其中高水平組根據移植後是否榦預治療分為兩組,迴顧性分析MRD水平與預後的關繫.結果 移植前MRD水平與移植後預後無明顯關繫,移植後第60、100天MRD高水平組患者移植後複髮率明顯高于低水平組.移植後第100天,MRD高水平榦預組、MRD高水平未榦預組、MRD低水平組1年無複髮生存率(RFS)分彆為100％、60.87％和91.30％,3年RFS分彆為85.71％、44.72％和68.48％,組間差異均有統計學意義(均P＜0.05).複髮患者首次檢齣MRD高水平的時間比臨床診斷複髮提前瞭2.5(1.0 ～26.0)箇月.移植後第100天,30例MRD高水平組患者中,7例患者及時接受榦預治療後均未複髮,而另外23例未接受榦預治療的患者中11例齣現複髮(P＜0.05).結論 多參數流式細胞術動態鑑測高危AL患者移植後MRD可以有效評估其臨床預後,併可根據移植後第100天MRD進行危險分層,MRD≥0.1％的患者預後較差,及時進行有效的榦預可以明顯降低其複髮率,增加長期生存率.
목적 분석급성백혈병(AL)고위환자이기인조혈간세포이식(allo-HSCT)전후미소잔류병변(MRD)수평여이식후예후적관계.방법 채용이CD45/SS설문적4색혹5색형광표기다삼수류식세포술(MFC)동태검측90례고위AL환자allo-HSCT전제30천、이식후제30、60、100천화6、9、12개월적MRD수평,이0.1％위계,장환자분위MRD고수평조(≥0.1％)화저수평조(＜0.1％),기중고수평조근거이식후시부간예치료분위량조,회고성분석MRD수평여예후적관계.결과 이식전MRD수평여이식후예후무명현관계,이식후제60、100천MRD고수평조환자이식후복발솔명현고우저수평조.이식후제100천,MRD고수평간예조、MRD고수평미간예조、MRD저수평조1년무복발생존솔(RFS)분별위100％、60.87％화91.30％,3년RFS분별위85.71％、44.72％화68.48％,조간차이균유통계학의의(균P＜0.05).복발환자수차검출MRD고수평적시간비림상진단복발제전료2.5(1.0 ～26.0)개월.이식후제100천,30례MRD고수평조환자중,7례환자급시접수간예치료후균미복발,이령외23례미접수간예치료적환자중11례출현복발(P＜0.05).결론 다삼수류식세포술동태감측고위AL환자이식후MRD가이유효평고기림상예후,병가근거이식후제100천MRD진행위험분층,MRD≥0.1％적환자예후교차,급시진행유효적간예가이명현강저기복발솔,증가장기생존솔.
Objective To explore the relationship between minimal residual disease (MRD) and the outcome of patients with high-risk acute leukemia (AL) undergoing allogeneic hematopoietic stem cell transplantation (HSCT).Methods By 4/5-color multi-parameter flow cytometry (MFC,CD45/SSC gating) for detecting MRD at pre- (day-30) and post-transplant( day + 30,+ 60,+ 100,6 months,9 months and 12 months),the investigators retrospectively analyzed the MRD levels and the prognosis of 90high-risk patients.According to the MRD cutoff value of 0.1％,the low-level and high-level groups were defined.In the high-level group,the patients were divided into two sub groups according to the subsequent treatment ( intervention therapy group and non-intervention therapy group).Results MRD pre-transplant had no predictive value for the clinical outcome.The patients with high levels of MRD post-transplant ( + 60 d and + 100 d) showed higher relapse rates than those of the low-level group.In addition,regarding MRD +100 d post-transplant,differences were significant among 3 groups (high-level MRD and intervention theray group,high-level MRD and non-intervention therapy group and low-level MRD group)including 1-year relapse-free survival (RFS) ( 100％ vs 60.87％ vs 91.30％,P ＜ 0.05 ) and 3-year RFS (85.71％ vs 44.72％ vs 68.48％,P ＜0.05).The median time from first high level MRD detected to clinical relapse was 2.5 (1 -26) months.In the high level MRD group ( + 100 d post-transplant),7 of 30 patients received intervention therapy without relapse.However another 23 patients had no intervention treatment and 11 of them relapsed latter (P ＜ 0.05 ).Conclusion The MFC-based quantification of MRD post-transplant reveals important prognostic information in patients with high-risk AL.MRD check point at day + 100 (cutoff:0.1％ ) may discriminate different risk populations.Those patients with MRD levels ≥0.1％ should receive early intervention at an early stage and a low tumor burden so as to reduce the relapse rate and boost survival.
