预处理前多参数流式细胞术监测的微小残留病对急性髓系白血病异基因造血干细胞移植预后的影响

OBJECTIVE: 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 (CR(1)-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 CR(1)-AML. METHODS: Between April 2012 and March 2015, consecutive 186 patients with CR(1)-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). ②With 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]. ③Multivariate 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 CR(1)-AML. CONCLUSION: MRD positive pre-conditioning was the only negative impact factor for patients with CR(1)-AML after allo-HSCT. MRD by MFC can be used to assess the prognosis of CR(1)-AML after allo-HSCT.