中国医师进修杂志
中國醫師進脩雜誌
중국의사진수잡지
CHINESE JOURNAL OF POSTGRADUATES OF MEDICINE
2015年
4期
266-269
,共4页
黄涛生%燕敬茹%杜凤%杨琦%任翠爱%崔景英
黃濤生%燕敬茹%杜鳳%楊琦%任翠愛%崔景英
황도생%연경여%두봉%양기%임취애%최경영
白血病,髓样%流式细胞术%肿瘤,残留%复发%预后
白血病,髓樣%流式細胞術%腫瘤,殘留%複髮%預後
백혈병,수양%류식세포술%종류,잔류%복발%예후
Leukemia,myeloid%Flow cytometry%Neoplasm,residual%Recurrence%Prognosis
目的 探讨急性髓细胞白血病(AML)在化疗获得第1次完全缓解(CR1)后用多参数流式细胞术(FCM)监测骨髓微小残留病(MRD)的临床意义.方法 选择AML CR1患者63例,定期利用四色多参数流式细胞仪检测骨髓MRD,以MRD≥10-4为阳性.按照最新美国国立综合癌症网络(NCCN)标准进行危险度分层:预后良好(20例)、预后中等(27例)、预后不良(16例).采用Kaplan-Meier法计算持续完全缓解(CCR)率,比较采用log-rank法.结果 预后良好患者骨髓MRD阳性率20%(4/20),预后中等患者为30%(8/27),预后不良患者为10/16;预后良好患者与预后中等患者骨髓MRD阳性率比较差异无统计学意义(P=0.454),预后不良患者与预后中等患者骨髓MRD阳性率比较差异有统计学意义(P=0.035.即MRD阳性22例,MRD阴性41例.MRD阳性患者与MRD阴性患者24和36个月CCR率比较差异有统计学意义[18%(4/22)比83%(34/41)和18%(4/22)比80%(33/41),P<0.01].结论 骨髓MRD与AML复发之间存在一定的关系,是判定预后的重要因素.应用FCM动态定时监测AML患者骨髓MRD对及时调整化疗强度、个体化治疗、预测预后、选择合适的治疗方法具有重要的临床意义.
目的 探討急性髓細胞白血病(AML)在化療穫得第1次完全緩解(CR1)後用多參數流式細胞術(FCM)鑑測骨髓微小殘留病(MRD)的臨床意義.方法 選擇AML CR1患者63例,定期利用四色多參數流式細胞儀檢測骨髓MRD,以MRD≥10-4為暘性.按照最新美國國立綜閤癌癥網絡(NCCN)標準進行危險度分層:預後良好(20例)、預後中等(27例)、預後不良(16例).採用Kaplan-Meier法計算持續完全緩解(CCR)率,比較採用log-rank法.結果 預後良好患者骨髓MRD暘性率20%(4/20),預後中等患者為30%(8/27),預後不良患者為10/16;預後良好患者與預後中等患者骨髓MRD暘性率比較差異無統計學意義(P=0.454),預後不良患者與預後中等患者骨髓MRD暘性率比較差異有統計學意義(P=0.035.即MRD暘性22例,MRD陰性41例.MRD暘性患者與MRD陰性患者24和36箇月CCR率比較差異有統計學意義[18%(4/22)比83%(34/41)和18%(4/22)比80%(33/41),P<0.01].結論 骨髓MRD與AML複髮之間存在一定的關繫,是判定預後的重要因素.應用FCM動態定時鑑測AML患者骨髓MRD對及時調整化療彊度、箇體化治療、預測預後、選擇閤適的治療方法具有重要的臨床意義.
목적 탐토급성수세포백혈병(AML)재화료획득제1차완전완해(CR1)후용다삼수류식세포술(FCM)감측골수미소잔류병(MRD)적림상의의.방법 선택AML CR1환자63례,정기이용사색다삼수류식세포의검측골수MRD,이MRD≥10-4위양성.안조최신미국국립종합암증망락(NCCN)표준진행위험도분층:예후량호(20례)、예후중등(27례)、예후불량(16례).채용Kaplan-Meier법계산지속완전완해(CCR)솔,비교채용log-rank법.결과 예후량호환자골수MRD양성솔20%(4/20),예후중등환자위30%(8/27),예후불량환자위10/16;예후량호환자여예후중등환자골수MRD양성솔비교차이무통계학의의(P=0.454),예후불량환자여예후중등환자골수MRD양성솔비교차이유통계학의의(P=0.035.즉MRD양성22례,MRD음성41례.MRD양성환자여MRD음성환자24화36개월CCR솔비교차이유통계학의의[18%(4/22)비83%(34/41)화18%(4/22)비80%(33/41),P<0.01].결론 골수MRD여AML복발지간존재일정적관계,시판정예후적중요인소.응용FCM동태정시감측AML환자골수MRD대급시조정화료강도、개체화치료、예측예후、선택합괄적치료방법구유중요적림상의의.
Objective To evaluate the clinical significance of bone marrow minimal residual disease (MRD) monitoring by multi-parameter flow cytometry (FCM) regularly after the first complete remission (CR1) in patients with acute myeloid leukemia (AML).Methods A total of 63 paitents with AML who had got CR1 after chemotherapy were regularly monitored for MRD in bone marrow by FCM,and MRD ≥ 10-4 was positive.According to the latest standards of National Comprehensive Cancer Network (NCCN) for disease risks,they were categorized into three groups:better risk group (20 cases),intermediate risk group (27 cases) and poor risk group (16 cases).The probability of continuous complete remission (CCR) was calculated by KaplanMeier formula,and the statistical difference between MRD positivc and MRD negative CCR probabilities was evaluated by log-rank test.Results The positive rates of MRD were 20%(4/20),30%(8/27) and 10/16 in better risk group,intermediate risk group and poor risk group respectively.The difference between better risk group and intermediate risk group had no statistical significance (P=0.454),and the difference between poor risk group and intermediate risk group had statistical significance (P =0.035).Twenty-two cases showed positive MRD,and 41 cases showed negative MRD.The probability of CCR at 24 and 36 months in MRD positive patients were 18% (4/22),18% (4/22),in MRD negative patients were 83% (34/41),80% (33/41),and there were significant differences (P < 0.01).Conclusions The dynamic detection of MRD by FCM can be used to evaluate the therapeutic effect and prognosis of AML.MRD monitoring has important clinical significance and can help to adjust the intensity of chemotherapy,carry out individualized treatment,predict prognosis,and choose appropriate therapy.