兰州大学机构库 >第一临床医学院
微小残留病灶对急性淋巴细胞白血病预后的价值
Alternative TitleThe Prognostic Value of Minimal Residual Disease in Acute Lymphoblastic Leukemia
张巧梅
Thesis Advisor李燕平
2019-03-31
Degree Grantor兰州大学
Place of Conferral兰州
Degree Name硕士
Degree Discipline临床检验诊断学
Keyword儿童 急性淋巴细胞白血病 流式细胞术 微小残留病灶 复发 总生存率
Abstract目的:动态监测急性淋巴细胞白血病(ALL)患者诱导缓解后微小残留病灶(MRD)水平,探讨不同检测时间点的MRD水平与ALL患者复发的关系以及不同检测时间点的MRD水平与3年总生存率(OS)的关系。     方法:采用流式细胞术(FCM)对2010年1月~ 2015年12月于兰州大学第一医院收治64例初诊ALL患者进行化疗期间第33天、第12周、第6个月、第9个月、第12个月骨髓MRD水平检测。根据MRD水平分为MRD阳性组和MRD阴性组。评价MRD阳性组和MRD阴性组的性别、年龄、亚型、染色体、融合基因、白细胞计数和化疗第15天骨髓象是否有统计学差异,分析ALL患者不同检测时间点的MRD水平与复发的关系,并探索MRD水平与患者3年OS的关系。结果:1、64例患者化疗期间,MRD阳性组和MRD阴性组的白细胞计数、BCR-ABL和MLL-AF4融合基因、化疗第15天骨髓象以及危险度分层相比差异有统计学意义(P<0.05);MRD阳性组和阴性组的性别、年龄、亚型、染色体、E2A-PBX1和TEL-AML1融合基因差异无统计学意义(P>0.05)。2、ALL患者在化疗期间第33天、第12周和第6个月MRD阳性组复发率显著高于MRD阴性组复发率,差异有统计学意义(P<0.05);第9个月和第12个月MRD阳性组与MRD阴性组复发率相比差异无统计学意义(P>0.05)。ALL患者化疗期间第33天和第12周MRD阳性组早期复发率显著高于晚期复发率,差异无统计学意义(P<0.05),第6个月、第9个月和第12个月MRD阳性组与MRD阴性组的早期和晚期复发率相比差异无统计学意义(P>0.05)。ALL患者化疗期间第33天和第12周MRD阳性组与阴性组的3年OS相比,差异有统计学意义(P<0.05),化疗期间第6个月、第9个月和第12个月MRD阳性组与阴性组3年OS率相比差异无统计学意义(P>0.05)。复发与未复发患者3年OS相比,差异有统计学意义(P<0.05),23例复发患者早期与晚期复发3年OS相比,差异有统计学意义(P<0.05)。结论:通过回顾性研究分析对64例ALL患者骨髓标本用流式细胞术对MRD进行动态监测,发现MRD对ALL预后可以做出早期预测,ALL患者化疗期间第33天和第12周MRD阳性的患者早期复发率增加;化疗期间MRD阳性出现的时间越早,3年总生存率越低。
Other AbstractObjective: Dynamically monitoring of minimal residual disease (MRD) levels after induction chemotherapy in patients with acute lymphoblastic leukemia (ALL). To explore the relationship between different MRD levels at different time points and relapse of ALL patients and the relationship between different MRD levels and 3-year overall survival at different time pointsMethods: Bone marrow MRD levels were measured by flow cytometry(FCM) in 64 cases with ALL during the 33rd, 12th week, 6th, 9th, and 12th months of chemotherapy in the first hospital of Lanzhou University from January 2010 to December 2015. According to the MRD levels, they were divided into positive MRD group and negative MRD group,to evaluate whether there was statistic difference in gender, age, subtype, chromosome, fusion gene, white blood cell count and bone marrow image on the 15th day of chemotherapy in MRD positive and negative groups. Analyse the relationships between MRD levels and relapse in children with ALL at different chemotherapy time points. At the same time,analyse the relationships between MRD levels and 3-year overall survival.Results: 1.There was statistical differences in the white blood cell count, the BCR-ABL and MLL-AF4 fusion genes, the 15th day of bone marrow chemotherapy, and the risk stratification between MRD positive and negative groups (P<0.05);There was no statistical differences in gender, age, subtype, chromosome,the fusion genes of E2A-PBX1 and TEL-AML1 between MRD positive and negative groups in the incidence of 64 children (P>0.05).2.The relapse rate of MRD positive group was significantly higher than MRD negative group at the 33th day , the 12th week and the 6th month of chemotherapy.There was statistical differences between two groups(P<0.05). There was no statistical differences in the relapse rate between the MRD-positive and negative groups at the 9th and the 12th month of chemotherapy. (P>0.05).3. The early relapse rate of MRD positive group was significantly higher than late relapse rate in children with ALL at the 33th day and the 12th week after chemotherapy. There was statistical differences between two groups (P<0.05). There was no statistical differences in the early and late relapse rates between the MRD positive and negative groups at the 6th, the 9th and the 12th month of chemotherapy (P>0.05).4.There was statistical differences in the 3-year OS rate between the MRD positive and negative groups at the 33th day and the 12th week after chemotherapy in children with ALL (P<0.05). There was no statistical differences in 3-year OS rate between the MRD-positive group and the MRD-negative group at the 6th,the 9th and the 12th month after chemotherapy (P>0.05).5. There was statistical differences between the relapse and non-relapse of children in the 3-year OS.There was statistical differences between the early and late relapse in the 3-year OS (P <0.05 ).Conclusions: MRD was dynamically monitored by flow cytometry in 64 patients with bone marrow specimens by retrospective study. MRD could predict the relapse of ALL in the prognosis of ALL.The positive of MRD in patients with ALL on the 33th day and the 12th week increases the early relapse rate. The earlier MRD positive time during chemotherapy, the lower 3-year overall survival rate.
Pages54
URL查看原文
Language中文
Document Type学位论文
Identifierhttp://ir.lzu.edu.cn/handle/262010/338820
Collection第一临床医学院
Affiliation第一临床医学院
First Author AffilicationFirst Clinical School
Recommended Citation
GB/T 7714
张巧梅. 微小残留病灶对急性淋巴细胞白血病预后的价值[D]. 兰州. 兰州大学,2019.
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