Cazzaniga Giovanni, Gaipa Giuseppe, Rossi Vincenzo, Biondi Andrea
Centro Ricerca M. Tettamanti, Università di Milano-Bicocca, Ospedale San Gerardo, Via Donizetti, 106, 20052 Monza, Italy.
Rev Clin Exp Hematol. 2003 Sep;7(3):292-323.
The use of minimal residual disease (MRD) measurement as a "surrogate" marker of molecular response to treatment, can potentially improve the evaluation of treatment response and enable estimates of the residual leukemic cell burden during clinical remission, thereby improving the selection of therapeutic strategies and, possibly, long-term clinical outcome. The most specific and sensitive methods for MRD monitoring currently available are polymerase chain reaction amplification of fusion transcripts and rearranged immunoglobulin or antigen-receptor genes, and flow cytometric detection of aberrant immunophenotypes. Several retrospective studies in childhood acute lymphoid leukemias (ALL) have used one of the different approaches for the detection of MRD. The strong association between MRD and risk of relapse was observed in children and adult patients irrespective of the methodology used. The promising results on the predictivity of MRD evaluation at the end of induction treatment has challenged the need for a new definition of remission. There is now urgent need to incorporate MRD data in clinical studies, properly designed to address treatment questions. In this context, several ongoing cooperative study groups have adopted a MRD-based risk group classification to explore whether a better tailored treatment would result in further improvement in cure rates for children with ALL.
将微小残留病（MRD）检测用作治疗分子反应的“替代”标志物，可能会改善对治疗反应的评估，并有助于估计临床缓解期残留白血病细胞的负荷，从而改进治疗策略的选择，并有可能改善长期临床结局。目前可用于MRD监测的最特异、最灵敏的方法是融合转录本和重排免疫球蛋白或抗原受体基因的聚合酶链反应扩增，以及异常免疫表型的流式细胞术检测。在儿童急性淋巴细胞白血病（ALL）中，有几项回顾性研究采用了不同的MRD检测方法之一。无论使用何种方法，在儿童和成人患者中均观察到MRD与复发风险之间存在密切关联。诱导治疗结束时MRD评估的预测性方面的令人鼓舞的结果，对缓解的新定义提出了挑战。现在迫切需要将MRD数据纳入经过适当设计以解决治疗问题的临床研究中。在这种背景下，几个正在进行的合作研究小组采用了基于MRD的风险组分类方法，以探讨更精准的治疗是否会进一步提高ALL患儿的治愈率。
