文章：

首次缓解期预后良好型急性髓系白血病中可测量残留病灶的动态评估、治疗与结局

Dynamic assessment of measurable residual disease in favorable-risk acute myeloid leukemia in first remission, treatment, and outcomes

原文发布日期：2021-12-06

DOI: 10.1038/s41408-021-00591-4

类型: Article

开放获取: 是

英文摘要：

We aimed to investigate outcomes of different post-remission treatment (PRT) choices based on dynamic measurable residual disease (MRD) by multiparameter flow cytometry in favorable-risk AML (FR-AML). Four hundred and three younger patients with FR-AML in first complete remission (CR1) were enrolled in this registry-based cohort study, including 173 who received chemotherapy (CMT), 92 autologous stem cell transplantation (auto-SCT), and 138 allogeneic SCT (allo-SCT). The primary endpoint was the 5-year overall survival (OS). Subgroup analyses were performed based on dynamic MRD after the 1st, 2nd, and 3rd courses of chemotherapy. In subgroups of patients with negative MRD after 1 or 2 course of chemotherapy, comparable OS was observed among the CMT, auto-SCT, and allo-SCT groups (p = 0.340; p = 0.627, respectively). But CMT and auto-SCT had better graft-versus-host-disease-free, relapse-free survival (GRFS) than allo-SCT in both subgroups. For patients with negative MRD after three courses of chemotherapy, allo-SCT had better disease-free-survival than CMT (p = 0.009). However, OS was comparable among the three groups (p = 0.656). For patients with persistently positive MRD after 3 courses of chemotherapy or recurrent MRD, allo-SCT had better OS than CMT and auto-SCT (p = 0.011; p = 0.029, respectively). Dynamic MRD might improve therapy stratification and optimize PRT selection for FR-AML in CR1.
 

摘要翻译： 

本研究旨在基于多参数流式细胞术检测的动态可测量残留病（MRD），探讨预后良好急性髓系白血病（FR-AML）患者不同缓解后治疗（PRT）选择的疗效。这项基于登记的队列研究纳入了403例首次完全缓解（CR1）的年轻FR-AML患者，其中173例接受化疗（CMT），92例接受自体造血干细胞移植（auto-SCT），138例接受异体造血干细胞移植（allo-SCT）。主要终点为5年总生存期（OS）。根据第1、2、3疗程化疗后的动态MRD结果进行亚组分析。在1或2个疗程化疗后MRD阴性亚组中，CMT、auto-SCT和allo-SCT组患者的OS无显著差异（分别为p=0.340；p=0.627）。但在这两个亚组中，CMT与auto-SCT的無移植物抗宿主病无复发生存（GRFS）均优于allo-SCT。对于3个疗程化疗后MRD阴性的患者，allo-SCT的无病生存优于CMT（p=0.009），但三组间OS无统计学差异（p=0.656）。对于3个疗程化疗后MRD持续阳性或复发的患者，allo-SCT的OS优于CMT和auto-SCT（分别为p=0.011；p=0.029）。动态MRD监测可能有助于优化CR1期FR-AML患者的治疗分层与缓解后治疗选择。

原文链接：

Dynamic assessment of measurable residual disease in favorable-risk acute myeloid leukemia in first remission, treatment, and outcomes