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本研究探讨多参数流式细胞术检测急性髓系白血病(AML)微量残留病(MRD)的方法和预后意义。采用4色标记的5组抗体组合确定初治患者的白血病相关免疫表型(LAIP),选取敏感的LAIP进行追踪MRD,共检测了随访95例AML患者的601份骨髓标本。以患者LAIP阳性细胞比例高于正常值+2倍标准差的定为MRD(+),低于此值的为MRD(-)。结果发现:以开始诱导化疗后半年内每2个月分为3组,3组中MRD(+)患者与MRD(-)患者之间的复发率和无复发生存率均具有显著性差异(p<0.05),1-2个月、3-4个月和5-6个月MRD(+)组的中位无复发生存期分别是11、11.5和11个月,MRD(-)组均未达中位生存期(p<0.05)。进一步比较诱导缓解后与巩固治疗1个疗程后患者MRD检测结果与临床的关系,发现这两个时间点MRD(+)组和MRD(-)组的患者复发率分别为57.14%与0%和91.67%与2.27%(p=0.000和p=0.000)。结论:多参数FCM检测MRD能够有效预测复发,治疗后应连续进行MRD检测。
This study was to investigate the method and prognostic significance of multi-parameter flow cytometry in the detection of micro-residual disease (AML) in patients with acute myeloid leukemia (AML). Five leukemia-associated immunophenotypes (LAIPs) were determined in the newly diagnosed patients using a combination of five antibodies labeled with a 4-color marker. MRP was performed using the sensitive LAIP. A total of 601 bone marrow samples from 95 AML patients were followed up. MRD (+) was defined as the patient’s LAIP-positive cell ratio was + 2 times the normal value of the normal and below this MRD (-). The results showed that there were significant differences in relapse rate and recurrence-free survival between MRD (+) patients and MRD (-) patients in three groups within three months after starting induction chemotherapy every two months <0.05). The median recurrence-free survival was 11, 11.5 and 11 months in the MRD (+) group at 1-2 months, 3-4 months and 5-6 months, respectively The median survival time (p <0.05). The results of MRD were compared with clinical results after one course of induction remission and consolidation therapy. The recurrence rates of MRD (+) group and MRD (-) group were 57.14% and 0% respectively at these two time points 91.67% and 2.27% (p = 0.000 and p = 0.000). Conclusion: Multi-parameter FCM can effectively predict the recurrence of MRD. MRD should be performed continuously after treatment.