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    • 流式细胞学在成人急性髓系白血病缓解后中枢神经系统白血病检测的临床应用及价值

    Zhanyun LIU,Yunxiang ZHANG,Jie HAO, Zhenyu LIU,Guangping DONG,Jingyi WANG,Xiaoge CHU,Junmin LI,Qiusheng CHEN,Yu CHEN

    Journal of Clinical Hematology（2020）

    Cited 6|Views21
    Abstract
    目的:探究成人急性髓系白血病(AML)中枢神经系统白血病(CNSL)的发生率、危险因素、治疗方案及流式细胞学(FCM)方法在检测CNSL中的价值.方法:收集2016-04-2018-12收治的缓解后AML患者308例.采集患者初诊时基础信息、生物学特征;缓解后腰穿脑脊液常规形态学及FCM检测结果.若患者样本采用FCM方法检测,发现存在一个群体有≥10个细胞表型异常,则定义为FCM检测阳性.对FCM检测阳性发生率、危险因素及患者预后等进行分析.结果:共221例患者在获得血液学缓解后接受了腰穿检查,其中207例脑脊液样本同时送检常规形态学及FCM检查.共22例患者FCM(+),阳性率为10.63％;其中,仅5例形态学检测发现异常细胞.根据患者FCM检测结果进行分组,对基线数据进行比较.结果发现脑脊液FCM(+)组初发时白细胞计数显著升高(P=0.012),FAB分型为M4及M5者占比高(P=0.021),均与FCM(-)组差异有统计学意义.伴有CBFβ-MYH11融合基因的患者在FCM(+)组中占31.8％,显著高于阴性组的8.6％(P=0.005);FLT3-ITD突变发生率在FCM(+)组中达22.7％,显著高于FCM(-)组的4.3％ (P=0.006).并且FCM(+)组具有不良分子生物学/细胞遗传学预后的患者比例更高,占31.8％;2组危险分层差异有统计学意义(P=0.016).脑脊液FCM(+)患者总生存率与阴性组相比差异无统计学意义.FCM(+)患者接受异基因造血干细胞移植治疗后,2年总生存率为83.3％;而非移植组为30.5％.结论:FCM能提高AML患者缓解后脑脊液异常细胞的检出率.高白、M4及M5亚型、FLT3-ITD突变、CBFβ-MYH11融合阳性及分子生物学/细胞遗传学预后不良,均为AML缓解后患者白血病中枢浸润的危险因素.脑脊液FCM检测阳性的患者建议按CNSL处理,并推荐异基因造血干细胞移植治疗.
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    【要点】：研究显示流式细胞学（FCM）在检测成人急性髓系白血病（AML）缓解后中枢神经系统白血病（CNSL）中具有高价值，可提高异常细胞的检出率，并识别出多个与CNSL发生相关的危险因素。
    

    【方法】：通过收集308例缓解后AML患者的基础信息、生物学特征及腰穿脑脊液常规形态学及FCM检测结果，分析FCM检测阳性的发生率、危险因素及患者预后。
    

    【实验】：研究对221例获得血液学缓解的患者进行腰穿检查，207例脑脊液样本同时进行常规形态学及FCM检查。结果发现22例FCM阳性，阳性率为10.63%，其中仅5例形态学检测发现异常细胞。实验使用的数据集为2016-04至2018-12期间收治的AML患者数据。