流式細胞術動態(tài)監(jiān)測微小殘留病在非清髓異基因造血干細胞移植治療急性白血病中的意義
發(fā)布時間：2018-10-23 21:30
【摘要】：目的研究非清髓造血干細胞移植(NST)后AL復發(fā)與移植前后免疫殘留水平的關系,確定用來預測NST后AL復發(fā)的免疫殘留最佳界值,評價依據(jù)免疫殘留輸注原供者外周血造血干細胞(DSI)和減停免疫抑制劑的早期干預措施預防白血病復發(fā)的效果。方法回顧性研究2011年1月至2015年12月在軍事醫(yī)學科學院附屬醫(yī)院血液科行NST的成人AL患者51例。所有患者移植前骨髓形態(tài)學完全緩解(CR),移植前35天內(nèi)有免疫殘留結果,移植后定期監(jiān)測免疫殘留。應用ROC曲線分析NST前與NST后免疫殘留預測AL復發(fā)的價值和并確定最佳界值。低水平免疫殘留組共33例(移植后每次檢測免疫殘留均0.2%),高水平免疫殘留組共18例(移植后動態(tài)監(jiān)測免疫殘留,至少一次≥0.2%),比較兩組的復發(fā)率。探索可能影響AL復發(fā)的相關因素。將免疫殘留大于或等于界值的病例分為DSI同時減停免疫抑制劑組及未給予DSI而有減停免疫抑制劑兩組,比較兩組的復發(fā)率。結果NST后AL2年累積復發(fā)率(CIR)為21.56%,復發(fā)組及未復發(fā)組的死亡率分別是81.8%和45%(P=0.036)。NST前免疫殘留與疾病復發(fā)的ROC曲線分析中,曲線下面積為0.53(P=0.783),NST后免疫殘留與疾病復發(fā)的ROC曲線分析中,曲線下面積為0.864(P0.001),NST后免疫殘留預測復發(fā)的最佳界值為0.2%。低水平免疫殘留與高水平免疫殘留組2年CIR分別是6.1%和50%(P=0.001)。NST后免疫殘留以0.2%為界值,預測AL復發(fā)的敏感度為81.8%,特異度為77.5%。多因素分析表明:NST后高水平免疫殘留是AL復發(fā)的獨立的高危因素,高水平免疫殘留組復發(fā)風險是低水平免疫殘留組的5.84倍(P=0.036)。高水平免疫殘留組中,DSI同時減停免疫抑制劑者1/4復發(fā),未給予DSI而有減停免疫抑制劑5/9復發(fā)(P=0.559)。結論1.NST后免疫殘留與AL復發(fā)率明顯相關,采用流式細胞術(FCM)動態(tài)監(jiān)測微小殘留病(MRD)是預測NST后AL早期復發(fā)的重要手段。2.NST后AL復發(fā)患者,治療難度大,死亡率高。3.本研究結果提示NST后免疫殘留≥0.2%預測AL復發(fā)有較高的敏感性和特異性,可作為判斷白血病移植后早期復發(fā)、并指導臨床盡快采取干預措施的指導依據(jù)。
[Abstract]:Objective to study the relationship between AL recurrence after non-myeloablative hematopoietic stem cell transplantation (NST) and the level of immune residue before and after transplantation, and to determine the best value of immune residue to predict the recurrence of AL after NST. To evaluate the effect of early intervention of peripheral blood stem cell (DSI) and immunosuppressant on leukemia recurrence. Methods A retrospective study of 51 adult AL patients who were treated with NST from January 2011 to December 2015 in Hematology Department of affiliated Hospital of the Academy of military Medical Sciences. The bone marrow morphology of all the patients before transplantation completely alleviated the immune residue in 35 days before (CR), transplantation, and the immune residue was monitored regularly after transplantation. The ROC curve was used to analyze the value of the immune residues before and after NST in predicting the recurrence of AL and to determine the best bounds. There were 33 cases in the low level group (0.2% for each time after transplantation) and 18 cases in the high level group (dynamic monitoring of immune residue after transplantation, 鈮，
本文編號：2290519
[Abstract]:Objective to study the relationship between AL recurrence after non-myeloablative hematopoietic stem cell transplantation (NST) and the level of immune residue before and after transplantation, and to determine the best value of immune residue to predict the recurrence of AL after NST. To evaluate the effect of early intervention of peripheral blood stem cell (DSI) and immunosuppressant on leukemia recurrence. Methods A retrospective study of 51 adult AL patients who were treated with NST from January 2011 to December 2015 in Hematology Department of affiliated Hospital of the Academy of military Medical Sciences. The bone marrow morphology of all the patients before transplantation completely alleviated the immune residue in 35 days before (CR), transplantation, and the immune residue was monitored regularly after transplantation. The ROC curve was used to analyze the value of the immune residues before and after NST in predicting the recurrence of AL and to determine the best bounds. There were 33 cases in the low level group (0.2% for each time after transplantation) and 18 cases in the high level group (dynamic monitoring of immune residue after transplantation, 鈮，
本文編號：2290519
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