微量残留病在儿童B系急性淋巴细胞白血病危险分层及预后中的临床意义

发布时间：2019-06-04 15:31

【摘要】：目的:探讨儿童B系急性淋巴细胞性白血病(B-ALL)治疗过程中不同时间点的微量残留病(minimal residual disease,M RD)水平在B-ALL危险分层及临床预后中的意义。方法:回顾性分析我院2008年8月1日至2013年1月1日以流式细胞术监测3个不同时间点(即诱导化疗第15天、第33天和治疗第12周)的380例BALL患儿骨髓M RD与5年无事件生存(EFS)率和总生存(OS)率的关系。结果:患儿的年龄、初诊白细胞数、染色体、MLL、BCR/ABL、预处理反应、第33天骨髓MRD与患儿的5年EFS率密切相关。多参数流式细胞术检测MRD有标记和MRD无标记与患儿5年EFS率之间差异无统计学意义(P=0.564);且各免疫表型与5年EFS率之间的差异也无统计学意义(P=0.84)。第15天MRD10~(-2)(P=0.004)、第33天MRD10~(-3)(P0.001)、第12周M RD10~(-3)(P0.001)的患儿5年EFS率及总生存率减低与不良预后明显相关。第33天MRD10~(-4)(阴性)、10~(-4)-10~(-3)、10~(-3)-10~(-2)、≥10~(-2)的5年EFS率分别为86.6±2.7%、77.5±4.9%、70.1±8.0%、44.8±9.9%(P0.001);5年OS率分别为89.5±2.7%、80±4.9%、76.0±7.8%、53.2±10.1%(P0.001)。结论:第33天M RD≥10~(-2)是B-ALL患儿5年EFS率和OS率显著减低的高危因素。缓解后动态监测MRD水平有助于预测B-ALL复发。
[Abstract]:Objective: To study the significance of the level of minimal residual disease (M RD) in the treatment of B-ALL in children with acute lymphoblastic leukemia (B-ALL) in the risk stratification and clinical prognosis of B-ALL. Methods: The flow cytometry was used to monitor three different time points from August 1,2008 to January 1,2013 (i.e., the 15th day of induction chemotherapy). The relationship of bone marrow M RD with no event-to-life (EFS) rate and total survival (OS) rate was observed in 380 patients with BALL at Day 33 and at Week 12. Results: The age, the number of leukocytes, the chromosome, the MLL, BCR/ ABL and the pre-treatment of the children were closely related to the 5-year EFS rate of the children. There was no significant difference (P = 0.564) between MRD-labeled and MRD-free and 5-year EFS in multi-parameter flow cytometry (P = 0.564), and there was no significant difference between the immunophenotypes and the 5-year EFS rate (P = 0.84). The 5-year EFS rate and overall survival rate of MRD10 ~ (-2) (P = 0.004), day 33 MRD10 ~ (-3) (P0.001) and 12-week M RD10 ~ (-3) (P0.001) were significantly related to the poor prognosis. The 5-year EFS rates of MRD10 ~ (-4) (negative),10 ~ (-4) -10 ~ (-3),10 ~ (-3) -10 ~ (-2), and 10 ~ (-2) were 86.6%, 2.7%, 77.5%, 4.9%, 70.1%, 8.0%, 44.8% and 9.9% (P0.001), respectively. The OS rate of 5 years was 89.5%, 2.7%,80% 4.9%, 76.0%, 53.2% (P 0.001), respectively. Conclusion: The 33-day M RD-10 ~ (-2) is a high risk factor for the 5-year EFS rate and OS rate of children with B-ALL. The post-response dynamic monitoring of the MRD level helps to predict the recurrence of B-ALL.
【作者单位】：苏州大学附属儿童医院血液科;上海交通大学附属第六人民医院南院即上海市奉贤区中心医院血液科;
【基金】：国家卫生和计划生育委员会科研基金(W201301)
【分类号】：R733.71

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