WT1联合多参数流式在急性髓系白血病预后的临床观察

目的 研究WT1基因定量联合多参数流式（FCM）在急性髓系白血病（AML）预后的临床观察。方法62例AML患者分为低危组、中危组、高危组;治疗上参照《成人急性髓系白血病（非急性早幼粒细胞白血病）中国诊疗指南2017年版》,用RT-qPCR方法测定患者WT1基因表达水平;同时用多参数流式细胞分析技术（FCM）分析患者低水平微小残留（MRD）水平;比较不同预后患者WT1表达及WT1表达与预后的关系。观察WT1基因定量联合FCM对AML患者预后评估的临床意义。对患者进行随访不低于2年。结果 AML患者WT1高表达比例为77.42%（48/62）,不同预后分型的AML患者WT1高表达有统计学差异（P <0.05）。在中、高危组的患者WT1高表达明显高于低危组。初发的WT1高表达与WT1低表达患者在诱导缓解率无统计学意义（P >0.05）,但WT1高表达患者的2年无病生存率、2年总生存率均WT1低表达患者,差异有统计学意义（35.41% vs 71.43%,47.92% vs 85.71% P < 0.05）。WT1基因联合FCM预测AML早期复发的敏感性、特异性均高于单独WT1基因和单独的FCM（P < 0.05）。结论 WT1在AML患者中高表达,与患者预后相关,联合FCM可有效的预测患者早期复发,可作为临床治疗及预后判断的靶点。

CLINICAL OBSERVATION OF WT1 COMBINED WITH UULTI-PARAMETER FLOW CYTOMETRY IN PROGNOSIS OF ACUTE MYELOID LEUKEMIA

Objective:To study the prognosis of acute myeloid leukemia (AML) patients with WT1 gene combined flow cytometry method (FCM). Methods: 62 AML patients were divided into low-risk group, intermediate-risk group and high-risk group, according to WHO MICM classification. All patients were treated under"the 2017 adult acute AML (non-Acute promyelocytic leukemia, non-APL) Chinese guidelines".The expression level of WT1 gene was measured by RT-qPCR method. FCM was used to analyze the minimal residual disease(MRD)level of patients. It was contrasted the expressions of WT1 in patients with different prognoses and the relationship between WT1 expressions and prognoses. It was observed the clinical significance of WT1 gene quantitative combined with FCM in evaluating the prognoses of AML patients.Results:The high expression rate of WT1 in AML patients was 77.42% (48/62), and there was no statistical difference in WT1 expressions of AML patients with the complete response rate (P>0.05). But the 2-year disease-free survival rate and 2-year overall survival rate of patients with the high WT1 expression were all lower than those with the low WT1 expression, and the differences were statistically significant (35.41% vs 71.43%,47.92% vs 85.71%, P<0.05). The sensitivity and specificity of WT1 gene combined with FCM to predict early recurrence of AML were higher than those of single gene and individual FCM (P<0.05). Conclusion:WT1 is highly expressed in AML patients and is closely related to the prognoses of patients, and WT1 combined with FCM can be used as a target for clinical treatment and prognosis judgment.