微小残留病在Ph染色体阴性急性B淋巴细胞白血病中的预后意义
Clinical significance of minimal residual disease in patients with Ph-negative precursor B-acute lymphoblastic leukemia
目的 探讨微小残留病(MRD)水平在Ph染色体阴性的急性B淋巴细胞白血病(Ph-B-ALL)中的预后意义.方法 采用多色流式细胞术对2010年9月至2017年11月初诊的193例Ph-B-ALL患者在治疗后1、3、6个月进行骨髓MRD监测,并对不同MRD水平患者的预后进行比较.结果 中位随访22(1~92)个月,所有193例患者共行497次MRD检测.1个月时MRD水平<0.1%和≥0.1%患者的3年预期元复发生存(RFS)率分别为74.5%和29.9%,3年预期总生存(OS)率分别为67.5%和30.3%;3个月时MRD水平阴性和阳性患者的3年预期RFS率分别为75.6%和29.7%,3年预期OS率分别为71.6%和27.8%;6个月时MRD水平阴性或阳性患者的3年预期RFS率分别为74.6%和11.6%,3年预期OS率分别为74.0%和15.7%,差异均有统计学意义(尸值均<0.001).3个监测点全部达到MRD阴性标准的患者与至少1次未达到MRD阴性标准的患者比较,3年预期RFS、OS率差异均有统计学意义(80.5%对30.5%,77.1%对29.4%,P值均<0.001).多因素分析结果显示,3个月时的MRD水平是Ph-B-ALL患者独立的预后因素之一.结论 治疗后MRD监测对Ph-B-ALL的预后判断有重要意义.
更多Objective To explore the predictive value of minimal residual disease (MRD) level in Ph-negative precursor B-acute lymphoblastic leukemia (ALL) patients.Methods De novo 193 Phnegative B-ALL patients from Sep 2010 to Nov 2017 were involved in the study.The patients' MRD evaluation which can be performed by multiparametric flow cytometry (MFC) after 1 month,3-month,6-month treatment.Relapse free survival (RFS) and overall survival (OS) were compared in patients with different MRD level.Results The median follow-up was 22 months.All patients was evaluated at 497 MRD level.Patients who reach the good MRD level at 1 month (< 0.1% or ≥0.1%),3-month (negative or positive),6-month (negative or positive) had a significantly higher probability of estimated RFS (74.5% vs 29.9%;75.6% vs 29.7%;74.6% vs 11.6%) and of estimated OS (67.5% vs 30.3%;71.6% vs 27.8%;74.0% vs 15.7%).Patients who reach the MRD negative at all 3 times had a significantly higher probability of estimated RFS (80.5% vs 30.5%) and better estimated OS (77.1% vs 29.4%) compared to patients with at least MRD failure in one time (P < 0.001).Multivariable analysis showed MRD level at 3-month was an independent prognostic factor for DFS and OS.Conclusion MRD is an important prognosis factor for Phnegative B-ALL patients.
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