流式细胞术动态监测微小残留病在非清髓异基因造血干细胞移植治疗急性白血病中的意义

发布时间：2018-10-23 21:30

【摘要】：目的研究非清髓造血干细胞移植(NST)后AL复发与移植前后免疫残留水平的关系,确定用来预测NST后AL复发的免疫残留最佳界值,评价依据免疫残留输注原供者外周血造血干细胞(DSI)和减停免疫抑制剂的早期干预措施预防白血病复发的效果。方法回顾性研究2011年1月至2015年12月在军事医学科学院附属医院血液科行NST的成人AL患者51例。所有患者移植前骨髓形态学完全缓解(CR),移植前35天内有免疫残留结果,移植后定期监测免疫残留。应用ROC曲线分析NST前与NST后免疫残留预测AL复发的价值和并确定最佳界值。低水平免疫残留组共33例(移植后每次检测免疫残留均0.2%),高水平免疫残留组共18例(移植后动态监测免疫残留,至少一次≥0.2%),比较两组的复发率。探索可能影响AL复发的相关因素。将免疫残留大于或等于界值的病例分为DSI同时减停免疫抑制剂组及未给予DSI而有减停免疫抑制剂两组,比较两组的复发率。结果NST后AL2年累积复发率(CIR)为21.56%,复发组及未复发组的死亡率分别是81.8%和45%(P=0.036)。NST前免疫残留与疾病复发的ROC曲线分析中,曲线下面积为0.53(P=0.783),NST后免疫残留与疾病复发的ROC曲线分析中,曲线下面积为0.864(P0.001),NST后免疫残留预测复发的最佳界值为0.2%。低水平免疫残留与高水平免疫残留组2年CIR分别是6.1%和50%(P=0.001)。NST后免疫残留以0.2%为界值,预测AL复发的敏感度为81.8%,特异度为77.5%。多因素分析表明:NST后高水平免疫残留是AL复发的独立的高危因素,高水平免疫残留组复发风险是低水平免疫残留组的5.84倍(P=0.036)。高水平免疫残留组中,DSI同时减停免疫抑制剂者1/4复发,未给予DSI而有减停免疫抑制剂5/9复发(P=0.559)。结论1.NST后免疫残留与AL复发率明显相关,采用流式细胞术(FCM)动态监测微小残留病(MRD)是预测NST后AL早期复发的重要手段。2.NST后AL复发患者,治疗难度大,死亡率高。3.本研究结果提示NST后免疫残留≥0.2%预测AL复发有较高的敏感性和特异性,可作为判断白血病移植后早期复发、并指导临床尽快采取干预措施的指导依据。
[Abstract]:Objective to study the relationship between AL recurrence after non-myeloablative hematopoietic stem cell transplantation (NST) and the level of immune residue before and after transplantation, and to determine the best value of immune residue to predict the recurrence of AL after NST. To evaluate the effect of early intervention of peripheral blood stem cell (DSI) and immunosuppressant on leukemia recurrence. Methods A retrospective study of 51 adult AL patients who were treated with NST from January 2011 to December 2015 in Hematology Department of affiliated Hospital of the Academy of military Medical Sciences. The bone marrow morphology of all the patients before transplantation completely alleviated the immune residue in 35 days before (CR), transplantation, and the immune residue was monitored regularly after transplantation. The ROC curve was used to analyze the value of the immune residues before and after NST in predicting the recurrence of AL and to determine the best bounds. There were 33 cases in the low level group (0.2% for each time after transplantation) and 18 cases in the high level group (dynamic monitoring of immune residue after transplantation, 鈮，

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