诱导化疗后动态监测微小残留病水平对儿童AML短期预后的预测价值

doi:10.3969/j.issn.1671-7171.2025.12.006

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摘要 【目的】探讨诱导化疗后动态监测微小残留病(MRD)水平对儿童急性髓系白血病(AML)短期预后的预测价值。【方法】96例AML患儿,根据化疗结束12个月内随访的疾病进展情况分为预后不良组(n=35)和预后良好组(n=61)。比较两组患儿临床相关指标及两次化疗后的MRD。根据MRD结果分析动态MRD转归模式及其对AML患儿预后的预测价值。【结果】两组患儿年龄、性别、法美英协作组(FAB)分型比较,差异无统计学意义(P>0.05);预后不良组初诊时白细胞计数(WBC)、Charlson合并症指数(CCI)评分、骨髓原始细胞≥50%、高危染色体核型占比高于预后良好组(P<0.05),血小板计数(PLT)低于预后良好组(P<0.05)。预后不良组诱导化疗后各时间点的MRD阳性率均高于预后良好组(P<0.05)。两组患儿动态MRD转归模式比较,差异有统计学意义(P<0.05),且预后不良组以持续阳性模式为主。受试者工作特征(ROC)曲线显示,诱导化疗Ⅰ后、诱导化疗Ⅱ后的MRD阳性率和动态MRD转归模式均能有效预测AML患儿的复发风险,其中动态MRD转归模式的预测效能更佳(P<0.05)。【结论】MRD水平的动态转归模式对AML患儿复发风险的预测效能优于诱导化疗Ⅰ/Ⅱ后单次检测,可作为预后评估的重要参考指标。

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	孙佳
	刘俊闪
	谢昕

关键词 ：白血病,髓样,急性, 抗肿瘤联合化疗方案, 肿瘤,残余, 预后

Abstract：【Objective】 To investigate the predictive value of dynamic monitoring of minimal residual disease (MRD) levels after induction chemotherapy for short-term prognosis in children with acute myeloid leukemia (AML).【Methods】 Ninety-six children with AML were enrolled and divided into a poor prognosis group (n=35) and a good prognosis group (n=61) according to disease progression within 12 months after completion of chemotherapy. Clinical parameters and MRD levels after the first and second courses of induction chemotherapy were compared between the two groups. The dynamic MRD evolution patterns and their predictive value for prognosis were analyzed based on MRD results.【Results】 There were no significant differences in age, sex, or French-American-British(FAB) classification between the two groups (P>0.05). Compared with the good prognosis group, the poor prognosis group had higher initial white blood cell (WBC) counts, higher Charlson Comorbidity Index (CCI) scores, a greater proportion of bone marrow blasts ≥50%, and a higher incidence of high-risk chromosome karyotypes, while platelet counts (PLT) were lower (P<0.05). The MRD-positive rates after the first and second induction chemotherapy cycles in the poor prognosis group were significantly higher than those in the good prognosis group (P<0.05). The distribution of dynamic MRD evolution patterns differed significantly between the two groups (P<0.05), with the persistent positive pattern predominating in the poor prognosis group. Receiver operating characteristic (ROC) curve analysis showed that MRD positivity after the first and second induction chemotherapy cycles, as well as dynamic MRD evolution patterns, could effectively predict relapse risk in children with AML. The dynamic MRD evolution demonstrated superior predictive performance (P<0.05).【Conclusion】 The dynamic evolution pattern of MRD provides better predictive value for relapse risk in children with AML than single-point MRD detection after the first or second induction chemotherapy, and can serve as an important reference indicator for prognosis assessment.

Key words： Leukemia, Myeloid, Acute Antineoplastic Combined Chemotherapy Protocols Neoplasm, Residual Prognosis

收稿日期: 2025-05-21

中图分类号:

R733.72

基金资助:河南省医学科技攻关计划联合共建项目(LHGJ20220718)

通讯作者: **E-mail:ljs-811@163.com

引用本文:

孙佳, 刘俊闪, 谢昕. 诱导化疗后动态监测微小残留病水平对儿童AML短期预后的预测价值[J]. 医学临床研究, 2025, 42(12): 2035-2038.
SUN Jia, LIU Junshan, XIE Xin. Predictive Value of Dynamic Monitoring of Minimal Residual Disease Levels after Induction Chemotherapy for Short-Term Prognosis in Children with Acute Myeloid Leukemia. JOURNAL OF CLINICAL RESEARCH, 2025, 42(12): 2035-2038.

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http://journal07.magtech.org.cn/yxlcyj/CN/10.3969/j.issn.1671-7171.2025.12.006 或 http://journal07.magtech.org.cn/yxlcyj/CN/Y2025/V42/I12/2035

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