摘要目的 分析预处理前多参数流式细胞术(MFC)监测的骨髓微小残留病(MRD)对急性髓系白血病(AML)异基因造血干细胞移植(allo-HSCT)预后的影响,探讨MFC监测MRD在AMLallo-HSCT预后评估中的价值.方法 回顾性分析2012年4月至2015年3月行allo-HSCT的186例AML患者,预处理前骨髓细胞形态学均达第1次完全缓解(CR1).采用8色MFC对预处理前骨髓进行MRD检测,任何水平异常均定义为MRD阳性.结果 ① 186例AML患者中151例MRD阴性;35例MRD阳性,其中25例MRD＜ 1％,10例MRD为1％～3％.②2年总体无病生存(DFS)率为80.0％(95％CI 68.5％～92.3％).与MRD阴性组比较,MRD阳性组DFS率低[62.9％ (95％ CI 50.6％～75.2％)对88.9％ (95％CI 76.6％～100.0％),P＜0.001]、复发率高[11.4％(95％ CI 4.1％～29.0％)对3.3％ (95％CI0.6％～20.9％),P=0.003]、非复发死亡率(NRM)高[25.7％(95％CI 8.1％～43.3％)对7.9％(95％CI l.3％～26.5％),P=0.001].继发性AML组DFS率低(P=0.004),NRM高(P=0.003).③多因素分析结果显示预处理前MFC检测的MRD阳性是DFS[HR=4.565(95％ CI 2.918～9.482),P＜0.001]、复发[HR=5.854(95％ CI l.538～22.288),P=0.010]及非复发死亡[HR=3.379(95％CI l.361～8.391),P=0.009]的独立危险因素.结论 预处理前MFC监测的MRD阳性是影响allo-HSCT治疗CR1-AML独立危险因素,MFC监测MRD可用于AML allo-HSCT的预后评估.

abstractsObjective To investigate the effect of minimal residual disease (MRD) monitoring by multiparameter flow cytometry (MFC) pre-conditioning on prognosis of acute myeloid leukemia in first complete remission (CR1-AML) after allogeneic hematopoietic stem cell transplantation (allo-HSCT),and to explore the value of MRD monitoring by MFC in the prognosis evaluation on allo-HSCT in CR1-AML.Methods Between April 2012 and March 2015,consecutive 186 patients with CR1-AML who underwent allo-HSCT were analyzed retrospectively.MRD in BM before conditioning was detected by eight-color MFC.Any level of residual disease was considered to be MRD positive.Results ①Of 186 patients,MRD was negative in 151 patients,positive in 35 patients (＜ 1％ in 25 patients and 1％ to 3％ in 10 patients).② With the median follow up of 18 (5-41) months,two-year DFS was 80.0％ (95％CI 68.5％-92.3％).Univariate analysis showed that MRD positive patients had lower DFS [62.9％ (95％CI 50.6％-75.2％) vs 88.9％ (95％ CI 76.6％-100.0％),P ＜ 0.001],higher relapse [11.4％ (95％ CI 4.1％-29.0％) vs 3.3％ (95％ CI 0.6％-20.9％),P=0.003] and higher NRM [25.7％ (95％ CI 8.1％-43.3％) vs 7.9％ (95％ CI 1.3％-26.5％),P=0.001] after HSCT compared with that of MRD negative patients.Secondary AML showed lower DFS than primary AML [60.0％ (95％CI 42.4％-76.6％) vs 86.0％ (95％CI 68.4％-100.0％),P=0.004].(③)Multivariate analysis indicated that MRD positive pre-HSCT was the independent risk factor on DFS [HR=4.565 (95％CI 2.918-9.482),P ＜ 0.001],relapse [HR=5.854(95％CI 1.538-22.288),P=0.010[and NRM [HR=3.379(95％CI 1.361-8.391),P=0.009] after allo-HSCT in CR1-AML.Conclusion MRD positive pre-conditioning was the only negative impact factor for patients with CR1-AML after allo-HSCT.MRD by MFC can be used to assess the prognosis of CR1-AML after allo-HSCT.