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目的:探究微小残留病灶(MRD)动态监测在急性T淋巴细胞白血病(T-ALL)中的应用及意义。方法:选取48例T-ALL患儿作为研究对象,追踪监测其不同治疗时间节点的MRD水平,同时进行5年或以上的跟踪随访,分析其临床特征和预后特点,评估患儿3年和5年后的累积生存率,并绘制生存曲线。结果:在诱导治疗后第35天,MRD水平≥1×10~(-4)的患儿,其完全缓解率远低于MRD水平<1×10~(-4)的患儿,成功缓解后的复发率也显著高于后者,组间比较差异有统计学意义(P<0.05);从远期疗效来看,首次诱导化疗获得完全缓解且MRD<1×10~(-4)的患儿3年和5年生存率分别为82.5%和71.2%,而首次化疗获得完全或部分缓解且MRD≥1×10~(-4)的患儿3年和5年生存率分别为34.5%和9.1%,组间比较差异有统计学意义(P<0.05)。结论:动态监测MRD水平对T-ALL患儿的复发预测,治疗方案调整及预后判断等具有重要的临床价值。
Objective: To investigate the application and significance of dynamic monitoring of minimal residual disease (MRD) in acute T-lymphoblastic leukemia (T-ALL). Methods: Forty-eight T-ALL children were selected as the research object to track the MRD levels at different treatment time points and follow-up for 5 years or more. The clinical features and prognosis were analyzed. Years after the cumulative survival rate, and draw the survival curve. Results: On the 35th day after induction therapy, the complete remission rate in children with MRD level ≥1 × 10 ~ (-4) was much lower than that in children with MRD level <1 × 10 ~ (-4) The recurrence rate was also significantly higher than the latter, the difference between the groups was statistically significant (P <0.05); from the long-term efficacy, the first induction of chemotherapy was completely relieved and MRD <1 × 10 -4 The 3-year and 5-year survival rates were 82.5% and 71.2% respectively, while the 3-year and 5-year survival rates of children with MRD≥1 × 10 ~ (-4) who achieved complete or partial remission after initial chemotherapy were 34.5% and 9.1%, there was significant difference between the two groups (P <0.05). Conclusions: The dynamic monitoring of MRD level has important clinical value in predicting relapse, adjusting treatment plan and prognosis in T-ALL children.