中华血液学杂志
中華血液學雜誌
중화혈액학잡지
Chinese Journal of Hematology
2012年
2期
84-87
,共4页
高雁群%吴彤%王卉%童春容%张维婕%王静波%卢岳%赵艳丽%周葭蕤%孙媛%张耀臣%纪树荃%陆道培
高雁群%吳彤%王卉%童春容%張維婕%王靜波%盧嶽%趙豔麗%週葭蕤%孫媛%張耀臣%紀樹荃%陸道培
고안군%오동%왕훼%동춘용%장유첩%왕정파%로악%조염려%주가유%손원%장요신%기수전%륙도배
流式细胞术%白血病,急性%微量残留病%造血干细胞移植
流式細胞術%白血病,急性%微量殘留病%造血榦細胞移植
류식세포술%백혈병,급성%미량잔류병%조혈간세포이식
Flow cytometry%Leukaemia,acute%Minimal residual disease%Hematopoietic stem cell transplantation
目的 研究急性白血病异基因造血干细胞移植(allo-HSCT)后采用流式细胞术(FCM)监测微量残留病(MRD)的意义.方法 自2007年1月至2008年1月采用FCM对102例初诊时未检测出白血病基因和染色体改变的急性白血病allo-HSCT后患者进行骨髓MRD检测(移植后1、2、3、6、12个月,部分高危患者增加检测频率),观察MRD结果与临床转归的关系,对有意义的MRD增高患者予以临床干预并采用FCM监测疗效.MRD＞ 0.01％为阳性.结果 ①移植后MRD持续阴性者71例,均为血液学完全缓解(CR),仅3例髓外复发,其无病生存( DFS)及总生存(0S)率分别为66.2％及90.1％.②移植后MRD阳性者27例,经过干预治疗(化疗加供者淋巴细胞输注、多种细胞因子诱导的杀伤细胞和NK细胞治疗),11例患者转阴,其DFS及OS率分别为63.6％及72.7％.另外16例血液学复发,其DFS及OS率分别为11.1％及25.0％.从MRD增高至血液学复发的中位时间为48(7～69)d.③移植后直接血液学复发者共4例,均死亡.结论 移植后采用FCM检测MRD:①MRD持续阴性组患者其DFS及OS率均明显高于MRD阳性组.②移植后出现MRD阳性的患者,通过干预性治疗,MRD再次转阴后,其DFS及OS率仍然高于持续阳性组.③移植后直接血液学复发的患者,其DFS及OS率极低,预后极差.采用FCM监测急性白血病allo-HSCT后MRD是一种敏感、特异、快速、简便的方法,可及时提示复发倾向,便于早期干预治疗,降低血液学复发风险,提高allo-HSCT后患者的DFS率.
目的 研究急性白血病異基因造血榦細胞移植(allo-HSCT)後採用流式細胞術(FCM)鑑測微量殘留病(MRD)的意義.方法 自2007年1月至2008年1月採用FCM對102例初診時未檢測齣白血病基因和染色體改變的急性白血病allo-HSCT後患者進行骨髓MRD檢測(移植後1、2、3、6、12箇月,部分高危患者增加檢測頻率),觀察MRD結果與臨床轉歸的關繫,對有意義的MRD增高患者予以臨床榦預併採用FCM鑑測療效.MRD＞ 0.01％為暘性.結果 ①移植後MRD持續陰性者71例,均為血液學完全緩解(CR),僅3例髓外複髮,其無病生存( DFS)及總生存(0S)率分彆為66.2％及90.1％.②移植後MRD暘性者27例,經過榦預治療(化療加供者淋巴細胞輸註、多種細胞因子誘導的殺傷細胞和NK細胞治療),11例患者轉陰,其DFS及OS率分彆為63.6％及72.7％.另外16例血液學複髮,其DFS及OS率分彆為11.1％及25.0％.從MRD增高至血液學複髮的中位時間為48(7～69)d.③移植後直接血液學複髮者共4例,均死亡.結論 移植後採用FCM檢測MRD:①MRD持續陰性組患者其DFS及OS率均明顯高于MRD暘性組.②移植後齣現MRD暘性的患者,通過榦預性治療,MRD再次轉陰後,其DFS及OS率仍然高于持續暘性組.③移植後直接血液學複髮的患者,其DFS及OS率極低,預後極差.採用FCM鑑測急性白血病allo-HSCT後MRD是一種敏感、特異、快速、簡便的方法,可及時提示複髮傾嚮,便于早期榦預治療,降低血液學複髮風險,提高allo-HSCT後患者的DFS率.
목적 연구급성백혈병이기인조혈간세포이식(allo-HSCT)후채용류식세포술(FCM)감측미량잔류병(MRD)적의의.방법 자2007년1월지2008년1월채용FCM대102례초진시미검측출백혈병기인화염색체개변적급성백혈병allo-HSCT후환자진행골수MRD검측(이식후1、2、3、6、12개월,부분고위환자증가검측빈솔),관찰MRD결과여림상전귀적관계,대유의의적MRD증고환자여이림상간예병채용FCM감측료효.MRD＞ 0.01％위양성.결과 ①이식후MRD지속음성자71례,균위혈액학완전완해(CR),부3례수외복발,기무병생존( DFS)급총생존(0S)솔분별위66.2％급90.1％.②이식후MRD양성자27례,경과간예치료(화료가공자림파세포수주、다충세포인자유도적살상세포화NK세포치료),11례환자전음,기DFS급OS솔분별위63.6％급72.7％.령외16례혈액학복발,기DFS급OS솔분별위11.1％급25.0％.종MRD증고지혈액학복발적중위시간위48(7～69)d.③이식후직접혈액학복발자공4례,균사망.결론 이식후채용FCM검측MRD:①MRD지속음성조환자기DFS급OS솔균명현고우MRD양성조.②이식후출현MRD양성적환자,통과간예성치료,MRD재차전음후,기DFS급OS솔잉연고우지속양성조.③이식후직접혈액학복발적환자,기DFS급OS솔겁저,예후겁차.채용FCM감측급성백혈병allo-HSCT후MRD시일충민감、특이、쾌속、간편적방법,가급시제시복발경향,편우조기간예치료,강저혈액학복발풍험,제고allo-HSCT후환자적DFS솔.
Objective To study the significance of flow cytometric monitoring minimal residual diseases (MRD) in patients with acute leukemia (AL) after allogeneic hemapoietic stem cell transplantation (HSCT).Methods From January 2007 and January 2008 MRD were detected by flow cytometry (FCM) in 402 bone marrow (BM) in 102 AL patients without leukemic gene and chromosomal changes at first diagnosis after HSCT( 1,2,3,6,12 months after HSCT; adding detection frequency in part of high risk patients),The relationship between the MRD results and clinical prognosis were observed.Patients with significantly higher MRD were treated and the effectiveness was monitored by FCM (MRD ＞ 0.01％ considered as positive).Results ①71 cases were persistently negative for MRD after HSCT and all them were in hematologic complete remission(CR).Only 3 cases had extramedullary relapse.The disease free survival (DFS) and overall survival (OS) were 66.2％ and 90.1％,respectively.②Of 27 MRD( + ) cases 11 converted to MRD negativity after chemotherapy plus donor lymphocyte infusion (DLI),CIK,NK cells.The DFS and OS were 63.6％ and 72.7％,respectively. Other 16 cases had hematologic relapse. The DFS and OS were 11.1％ and 25.0％,respectively.The median time from MRD increasing to hematologic relapse was 48 days ( 7 - 69 day).③Four cases had hematologic relapse after HSCT and died in the end.Conclusions ①The DFS and the OS in MRD( - ) cases are significantly higher than those of MRD( + ) cases.②MRD( + ) patients after HSCT coveted to MRD ( - ) after intervention.Therapy,whose DFS and the OS are still significantly higher than those of MRD ( + ) cases.③Patients with hematologic relapse after HSCT have the worst prognosis and the DFS and OS are significantly low.FCM monitoring of MRD in patients after HSCT is a sensitive,specific,quick and simple method.It can indicate recurrent state in time,facilitates early intervention,reduces the hematologic relapse risk and improves DFS.
