文章：

可测量残留病状态与第二次完全缓解期急性髓系白血病移植结局：EBMT急性白血病工作组研究

Measurable residual disease status and outcome of transplant in acute myeloid leukemia in second complete remission: a study by the acute leukemia working party of the EBMT

原文发布日期：2021-05-12

DOI: 10.1038/s41408-021-00479-3

类型: Article

开放获取: 是

英文摘要：

Measurable residual disease (MRD) prior to hematopoietic cell transplant (HCT) for acute myeloid leukemia (AML) in first complete morphological remission (CR1) is an independent predictor of outcome, but few studies address CR2. This analysis by the Acute Leukemia Working Party of the European Society for Blood and Marrow Transplantation registry assessed HCT outcomes by declared MRD status in a cohort of 1042 adult patients with AML CR2 at HCT. Patients were transplanted 2006–2016 from human leukocyte antigen (HLA) matched siblings (n = 719) or HLA 10/10 matched unrelated donors (n = 293). Conditioning was myeloablative (n = 610) or reduced-intensity (n = 432) and 566 patients (54%) had in-vivo T cell depletion. At HCT, 749 patients (72%) were MRD negative (MRD NEG) and 293 (28%) were MRD positive (MRD POS). Time from diagnosis to HCT was longer in MRD NEG than MRD POS patients (18 vs. 16 months (P < 0.001). Two-year relapse rates were 24% (95% CI, 21–28) and 40% (95% CI, 34–46) in MRD NEG and MRD POS groups (P < 0.001), respectively. Leukemia-free survival (LFS) was 57% (53–61) and 46% (40–52%), respectively (P = 0.001), but there was no difference in terms of overall survival. Prognostic factors for relapse and LFS were MRD NEG status, good risk cytogenetics, and longer time from diagnosis to HCT. In-vivo T cell depletion predicted relapse.
 

摘要翻译： 

对于首次达到完全形态学缓解（CR1）的急性髓系白血病（AML）患者，在造血细胞移植（HCT）前存在的可测量残留病（MRD）是预后的独立预测因素，但针对第二次缓解（CR2）的研究较少。本次欧洲血液和骨髓移植学会急性白血病工作委员会基于登记资料的分析，评估了1042例在CR2期接受HCT的成年AML患者中，根据申报的MRD状态所对应的移植结果。患者于2006年至2016年间接受移植，供体来源为人类白细胞抗原（HLA）全相合同胞（n=719）或HLA 10/10全相合无关供者（n=293）。预处理方案采用清髓性（n=610）或降低强度方案（n=432），其中566例患者（54%）接受了体内T细胞清除。移植时，749例患者（72%）为MRD阴性（MRD NEG），293例（28%）为MRD阳性（MRD POS）。MRD阴性患者从诊断到移植的时间长于MRD阳性患者（18个月 vs. 16个月，P<0.001）。MRD阴性组与阳性组的两年复发率分别为24%（95% CI，21-28）和40%（95% CI，34-46）（P<0.001）；无白血病生存率（LFS）分别为57%（53-61）和46%（40-52）（P=0.001），但总生存率无显著差异。影响复发和无白血病生存的预后因素包括MRD阴性状态、良好风险细胞遗传学以及从诊断到移植的较长间隔时间。体内T细胞清除是复发的预测因素。

原文链接：

Measurable residual disease status and outcome of transplant in acute myeloid leukemia in second complete remission: a study by the acute leukemia working party of the EBMT