The purpose of this study was to detect the minimal residual disease (MRD) in peripheral blood of newly diagnosed patients with acut myeloid leukemia (AML) on day 8 of induction chemotherapy and analyze the correlation between day 8 MRD (D8RD) and therapeutic effectiveness. 29 adult patients (13 males and 16 females, aged 16 -75 years, median 41 years) with AML diagnosed and treated in West China Hospital from September 2009 to June 2010 were analyzed and followed up in the study. The leukemia-associated aberrant immunophenotype (LAP) of all the patients were detected by multiparameter flow cytometry (FCM) before therapy. The level of MRD in the peripheral blood at day 8 of induction chemotherapy was detected by FCM based on the LAIP. The overall survival curve was drawn by calculation using Kaplan-Meier method using, and the comparison between different groups was carried out by Log-rank test. The results indicated that after first course therapy, the levels of peripheral D8RD in 7 out of 29 AML cases were lower than 0.01% (negative group), and that in another 22 cases were higher than 0.01% (0.08% -55%, positive group). The sex, age, WBC, LDH, percentage of bone marrow blasts at diagnosis in these groups were not statistically different. 6 cases achieved CR(86% ) in D8RD negative group, and also 6 cases achieved CR (27% ) in D8RD positive group, CR rate in D8RD negative group was higher than in D8RD positive group (86% vs 27% , P < 0.05). The median follow-up of 29 cases lasted for 15 months; the 1-year overall survival rate of D8RD negative and D8RD positive groups was 100 % and 39.4% , respectively (P < 0. 01). It is concluded that MRD level in peripheral blood at day 8 of induction chemotherapy is an early index to predict clinical efficacy of induction therapy in AML.%本研究旨在检测初发急性髓系白血病(AML)患者诱导化疗第8天外周血残存的白血病细胞数量,探索其与诱导缓解及生存时间之间的关系.收集华西医院血液科2009年9月至2010年6月的29例初发AML患者的临床和实验室资料,其中男13例,女16例,中位年龄41(16-75)岁.根据初诊时白血病相关免疫表型特征(LAIP),采用流式细胞术检测患者诱导化疗第8天外周血微小残留病(MRD)细胞数量；应用Kaplan-Meier法计算生存曲线,对数秩检验进行单因素生存分析,观察患者外周血化疗第8天MRD水平与治疗后完全缓解率(CR)及总体生存率之间的关系.结果表明,29例AML患者经第1疗程化疗后,7例外周血MRD水平低于0.01％(阴性组),其余22例外周血MRD水平高于0.01％(0.08％-55％,阳性组)；两组患者在性别、年龄、WBC、乳酸脱氢酶水平、骨髓原始细胞比例等均无统计学差异.7例MRD阴性组中6例达CR(86％),22例MRD阳性组中6例达CR(27％),CR率差异有统计学意义(P＜0.05).随访时间1-28个月(中位时间15个月),MRD阴性组患者中位生存期为19个月,MRD阳性纽患者中位生存期为9个月(P＜0.05),MRD阴性组1年生存率(100％)明显高于阳性组(39.4％,P＜0.01).结论:采用流式细胞术检测AML患者诱导化疗后第8天外周血MRD水平能较好的预测患者的CR率与长期生存率,MRD阴性患者有更高的CR率和更长的生存期.
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