文章：

在异基因造血干细胞移植前，通过流式细胞术或细胞遗传学检测到的微小残留病与急性髓系白血病的预后不良相关

Minimal residual disease by either flow cytometry or cytogenetics prior to an allogeneic hematopoietic stem cell transplant is associated with poor outcome in acute myeloid leukemia

原文发布日期：2017-11-27

DOI: 10.1038/s41408-017-0007-x

类型: Article

开放获取: 是

英文摘要：

Relapsed acute myeloid leukemia (AML) is a significant challenge after allogeneic hematopoietic cell transplant (HCT). Multiparameter flow cytometry (MFC), conventional cytogenetics (CG), and fluorescence in situ hybridization (FISH) are routinely performed on bone marrow specimens prior to HCT to assess disease status. We questioned the extent by which pre-HCT evidence of minimal residual disease (MRD) detected by these standard assays, corresponded with post-HCT relapse. We conducted a single center, retrospective study of 166 AML patients who underwent HCT. Thirty-eight of one hundred sixty-six (23%) patients in complete remission (CR) or CR with incomplete count recovery (CRi) had MRD detectable by MFC, CG, or FISH. MRD was more frequently seen in patients with poor risk karyotype at diagnosis (P = 0.011). MRD-negative patients (MRDneg) had significantly longer overall survival (OS) and relapse-free survival than patients who were MRD positive (MRDpos) (P = 0.002 and 0.013, respectively). In patients with MRDpos prior to HCT, the presence of acute graft vs. host disease (GVHD) (grade ≥ 2) or chronic GVHD significantly improved progression free survival (PFS) (hazard ratio (HR) = 0.053 (95% confidence interval (CI): 0.01–0.279), P = 0.0005) and OS (HR = 0.211 (95% CI: 0.081–0.547), P = 0.0014).

摘要翻译： 

复发急性髓系白血病（AML）是异基因造血细胞移植（HCT）后面临的重大挑战。移植前常规通过多参数流式细胞术（MFC）、常规细胞遗传学（CG）和荧光原位杂交（FISH）对骨髓标本进行疾病状态评估。我们探讨了移植前通过这些标准检测发现的微小残留病（MRD）与移植后复发的关联程度。我们对166例接受HCT的AML患者进行了单中心回顾性研究。在达到完全缓解（CR）或血细胞计数不完全恢复的完全缓解（CRi）的患者中，38/166例（23%）通过MFC、CG或FISH检测到MRD。诊断时具有不良风险核型的患者更常见MRD阳性（P=0.011）。与MRD阳性患者相比，MRD阴性患者的总生存期和无复发生存期显著延长（分别为P=0.002和P=0.013）。在移植前MRD阳性的患者中，急性移植物抗宿主病（GVHD）（≥2级）或慢性GVHD的存在显著改善了无进展生存期（风险比=0.053，95%置信区间：0.01-0.279，P=0.0005）和总生存期（风险比=0.211，95%置信区间：0.081-0.547，P=0.0014）。

原文链接：

Minimal residual disease by either flow cytometry or cytogenetics prior to an allogeneic hematopoietic stem cell transplant is associated with poor outcome in acute myeloid leukemia