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目的:研究急性白血病缓解期微小残留病灶(MRD)变化情况及其与预后的关系。方法:对62例成年人急性淋巴细胞白血病(ALL)完全缓解患者(男34例,女28例)和126例成年人急性髓细胞白血病(AML)完全缓解患者(男67例,女59例),采用流式细胞术检测骨髓中MRD,与传统骨髓形态学检查结果进行比较。所有患者平均跟踪随访6(3~24)个月,记录MRD值的变化及相应的预后情况:是否复发及复发时间,骨髓确诊复发的时间,不同性别、年龄、难治性的复发情况。结果:ALL患者共有骨髓标本174份,MRD阳性146份,其中31份标本MRD≥0.05,MRD阴性(MRD<0.001)28份。骨髓确诊复发24例。其中18例患者MRD持续阳性于9~24个月后出现骨髓复发,较骨髓确诊复发平均提前6个月。预测ALL不同治疗时间MRD诊断复发的敏感性均为100%;特异性1~12个月为76.9%,13~24个月为77.8%,差异无统计学意义(P>0.05)。126例AML患者检测完全缓解时MRD共126次,骨髓确诊复发21例。ALL和AML患者均可见MRD>0.001时复发率明显升高,而复发率与性别、年龄、是否为难治性无关(P>0.05),MRD≥0.01患者的复发时间明显短于MRD≤0.005和0.0050.001时复发的可能性大。连续定期动态观察对复发提示、预后预测及个体化治疗的指导有重要意义。
Objective: To study the changes of minimal residual disease (MRD) in acute leukemia and its relationship with prognosis. Methods: A total of 62 adult patients with acute lymphoblastic leukemia (ALL) with complete remission (34 males and 28 females) and 126 adult patients with complete remission of acute myeloid leukemia (AML) (67 males and 59 females) . The bone marrow MRD was detected by flow cytometry and compared with the results of conventional bone marrow biopsy. All patients were followed up for an average of 6 (3-24) months. The changes of MRD and the corresponding prognosis were recorded: whether recurrence and recurrence, time of bone marrow recurrence, gender, age and refractory recurrence. Results: There were 174 bone marrow samples and 146 MRD positive samples from ALL patients. Among them, 31 samples had MRD≥0.05 and MRD negative (MRD <0.001) 28. Bone marrow diagnosis of recurrence in 24 cases. Among them, 18 cases of patients with MRD persistent positive bone marrow recurrence after 9 to 24 months, compared with the diagnosis of bone marrow recurrence average of 6 months earlier. The sensitivity of predicting the MRD diagnosis and treatment of ALL at different treatment time was 100%. The specificity of 1-12 months was 76.9% and that of 13-24 months was 77.8%. There was no significant difference (P> 0.05). 126 cases of AML patients with complete remission MRD were detected 126 times, 21 cases of bone marrow recurrence diagnosis. The relapse rate was significantly higher in patients with ALL and AML than those with MRD> 0.001 (P> 0.05). The relapse rate was significantly shorter in MRD≥0.01 than in MRD≤0.005 and 0.005 0.001, the possibility of recurrence. Continuous dynamic observation on recurrence prompts, prognosis prediction and individualized treatment guidance is of great significance.