微小残留病指导的急性髓细胞白血病分层治疗

常英军; 赵晓甦

doi:10.13201/j.issn.1004-2806.2023.05.003

微小残留病指导的急性髓细胞白血病分层治疗

常英军^1, ,,
赵晓甦¹

- 北京大学人民医院血液科北京大学血液病研究所国家血液系统疾病临床医学研究中心造血干细胞移植治疗血液病北京市重点实验室(北京，100044)
基金项目:
首都特色重点项目(No：Z221100007422008)；国家自然科学基金面上项目(No：82070185)

详细信息

作者简介:
常英军，主任医师，二级教授，博士研究生(博士后)导师。科技部重点领域创新团队负责人，2021年入选第六批国家“万人计划”科技创新领军人才；同年获人民名医“优秀风范”称号。现任北京大学医学部血液系主任、北京大学人民医院血液科副主任。中华医学会血液学分分会第十一届委员会委员、实验诊断学组副组长，中华医学会血液学分会第九届、第十届青年委员会副主任委员，美国免疫学会国际会员，海峡两岸医药卫生交流协会血液病学专业委员会第三届委员会副主任委员、中国病理生理学会实验血液学会委员等。承担“863”项目、国家自然科学基金委重大项目子课题、首都特色项目重点课题和京津冀基础研究合作项目等10余项课题。以主要完成人身份获国家科技进步二等奖2项，中华医学科技一等奖2项、二等奖2项及教育部高校科技进步一等奖1项。现为Exp Hematol & Oncol副主编、《白血病·淋巴瘤》副总编辑；J Hematol Oncol、Expert Rev Hematol、Advance in Therapy和《中华血液学杂志》等杂志的编委；任Lancet和Lancet Heamatol等20余种国际杂志的审稿专家。截至目前，以通讯(包括共同通讯)或第一(包括共同第一)作者身份在J Clin Oncol、Blood、Cell Discov等国内外学术期刊上发表论文120余篇

通讯作者: 常英军，E-mail：rmcyj@bjmu.edu.cn

中图分类号: R733.71

收稿日期: 2023-03-07

刊出日期: 2023-05-01

Minimal residual disease directed therapy for patients with acute myeloid leukemia

CHANG Yingjun^1, ,,
ZHAO Xiaosu¹

- Peking University People's Hospital & Peking University Institute of Hematology, National Clinical Research Center for Hematologic Disease, Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, Beijing, 100044, China

More Information

Corresponding author: CHANG Yingjun, E-mail: rmcyj@bjmu.edu.cn

Received Date: 07 March 2023

Publish Date: 01 May 2023

摘要

摘要: 微小残留病(MRD)已被常规用于急性髓细胞白血病(AML)患者的疗效评估和复发预测。本文从异基因造血干细胞移植适应证、移植方式、预处理方案以及移植后复发预防等方面讨论了MRD指导的个体化分层治疗。未来的研究应聚焦AML患者MRD检测及干预新方法的建立。
- 微小残留病 /
- 急性髓细胞白血病 /
- 个体化治疗
Abstract: Minimal residual disease (MRD) has been used routinely for curative effect evaluation and relapse prediction for patients with acute myeloid leukemia (AML). It discussed MRD directed individual therapy for AML in view of transplant indications, transplant modality selection, conditioning regimen and relapse prevention after allogeneic stem cell transplantation. Future directions should focus on the establishment of new methods for MRD detection and novel strategies for MRD intervention.
- minimal residual disease /
- acute myeloid leukemia /
- individual therapy

HTML全文

图 1 MRD的概念及其与临床预后的关系

下载: 全尺寸图片幻灯片

图 2 MRD指导的AML个体化治疗策略

下载: 全尺寸图片幻灯片

表 1 AML患者各种MRD检测方法优缺点比较

检测方法	敏感性	常规应用	评价
MFC	10^-5~10^-3	是	优点：简便快捷、花费低，适用90%以上的AML患者；缺点：抗原漂移，不能确定特定白血病亚群，分析过程复杂
RQ-PCR
融合基因/基因突变	10^-6~10^-4	是	优点：特异性好，敏感性高，相对便宜，易标准化；缺点：耗时间，要求靶基因在疾病治疗过程中稳定表达，适用部分患者，RNA不稳定，仅适用30%~60%的患者
WT1	10^-2	是	优点：适用80%~90%的AML患者；缺点：敏感性低，缺乏疾病特异性
dd-PCR	10^-6~10^-4	否	优点：绝对定量，不需要标准化曲线；缺点：同RQ-PCR
测序技术
群体细胞水平	10^-6~10^-3	否	优点：可以同时检测多种突变位点，可观察克隆演变，高通量；缺点：花费高，结果易受背景噪音影响，无标准化
单细胞水平	10^-4~10^-3	否	优点：可以同时检测多种突变位点，可在单细胞水平观察克隆演变，可实现单细胞水平同时检测DNA、RNA和表面表型；缺点：花费高，单细胞核酸量有限，结果易受背景噪音影响，无标准化，等位基因遗漏

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