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目的研究急性髓细胞性白血病(AML)患者第1次诱导治疗后和第1次完全缓解时多参数流式细胞术(MFC)监测白血病微小残留(MRD)对预测疾病复发和判断预后的作用,探讨MRD监测的临床价值。方法回顾性研究246例成人AML患者治疗及MRD的监测数据,分析MRD水平与疾病复发和预后的相关性。结果 (1)第1次标准方案诱导化疗后,ROC分析确定MRD阈值为1.5×10-2,Cox比例风险模型显示相对于MRD阴性组,MRD阳性组的相对危险度(RR)为2.41。在缓解后采用联合方案化疗的患者中,MRD阳性组和MRD阴性组的中位无复发生存时间(RFS)分别为(19.45±3.74)个月和(56.46±4.28)个月,中位总生存时间(OS)分别为(29.37±4.47)个月和(77.97±4.30)个月,差异均有高度统计学意义(均P<0.01)。(2)第1次达完全缓解时,ROC分析所确定的MRD阈值为3.0×10-3,Cox比例风险模型显示相对于MRD阴性组,MRD阳性组的RR值为1.75。缓解后采取联合化疗,MRD阳性组和MRD阴性组患者的中位RFS分别为(28.36±3.40)个月和(55.70±4.32)个月,中位OS分别为(39.30±3.73)个月和(70.19±4.34)个月,差异均有高度统计学意义(均P<0.01)。结论 MFC检测MRD在AML诱导治疗过程中具有预测复发、判断预后的价值。
Objective To investigate the effect of multi-parameter flow cytometry (MFC) for detecting leukemia minimal residual disease (MRD) on prediction of disease recurrence and prognosis after first induction and first complete remission in patients with acute myeloid leukemia (AML) To explore the clinical value of MRD monitoring. Methods A retrospective study of 246 adult patients with AML treatment and MRD monitoring data to analyze the correlation between MRD levels and disease recurrence and prognosis. Results (1) RCC analysis showed that the MRD threshold was 1.5 × 10-2 after the first standard chemotherapy. The Cox proportional hazards model showed that the relative risk (RR) of MRD-positive patients was 2.41 compared with MRD-negative patients. The median duration of relapse-free survival (RFS) was (19.45 ± 3.74) months and (56.46 ± 4.28) months in patients with MRD-positive and MRD-negative, respectively, after median remission The time (OS) was (29.37 ± 4.47) months and (77.97 ± 4.30) months, respectively. The differences were highly statistically significant (all P <0.01). (2) On the first complete remission, the MRD threshold determined by ROC analysis was 3.0 × 10-3. The Cox proportional hazards model showed an RR of 1.75 in MRD-positive patients relative to MRD-negative patients. The median RFS was (28.36 ± 3.40) months and (55.70 ± 4.32) months in patients with MRD-positive and MRD-negative, respectively. The median OS was (39.30 ± 3.73) months and 70.19 ± 4.34) months, the differences were highly statistically significant (both P <0.01). Conclusion The detection of MRD by MFC has the value of predicting recurrence and prognosis in the course of AML induction therapy.