诱导后微小残留病状态可预测 Ph 阴性成人急性淋巴细胞白血病的标准和高危患者的预后。波兰成人白血病研究组 ALL 4-2002 微小残留病研究。

Status of minimal residual disease after induction predicts outcome in both standard and high-risk Ph-negative adult acute lymphoblastic leukaemia. The Polish Adult Leukemia Group ALL 4-2002 MRD Study.

机构信息

Department of Haematology and Bone Marrow Transplantation, Silesian Medical University, Katowice, Poland.

出版信息

Br J Haematol. 2008 Jun;142(2):227-37. doi: 10.1111/j.1365-2141.2008.07185.x. Epub 2008 May 19.

DOI:10.1111/j.1365-2141.2008.07185.x

PMID:18492099

Abstract

The treatment of adults with Philadelphia-negative acute lymphoblastic leukaemia (ALL) depends on the presence of risk factors including age, white blood cell count, immunophenotype and time to complete remission. In recent years, status of minimal residual disease (MRD) has been postulated as an additional risk criterion. This study prospectively evaluated the significance of MRD. Patients were treated with a uniform Polish Adult Leukemia Group (PALG) 4-2002 protocol. MRD status was assessed after induction and consolidation by multiparametric flow cytometry. Out of 132 patients included (age, 17-60 years), 116 patients were suitable for analysis. MRD level >/=0.1% of bone marrow cells after induction was found to be a strong and independent predictor for relapse in the whole study population (P < 0.0001), as well as in the standard risk (SR, P = 0.0003) and high-risk (P = 0.008) groups. The impact of MRD after consolidation on outcome was not significant. The combination of MRD status with conventional risk stratification system identified a subgroup of patients allocated to the SR group with MRD <0.1% after induction who had a very low risk of relapse of 9% at 3 years as opposed to 71% in the remaining subjects (P = 0.001). We conclude that MRD evaluation after induction should be considered with conventional risk criteria for treatment decisions in adult ALL.

摘要

成人费城阴性急性淋巴细胞白血病（ALL）的治疗取决于风险因素的存在，包括年龄、白细胞计数、免疫表型和达到完全缓解的时间。近年来，微小残留病（MRD）状态被认为是另一个风险标准。本研究前瞻性地评估了 MRD 的意义。患者采用统一的波兰成人白血病组（PALG）4-2002 方案进行治疗。通过多参数流式细胞术在诱导和巩固后评估 MRD 状态。在纳入的 132 例患者中（年龄 17-60 岁），有 116 例适合进行分析。在整个研究人群中（P<0.0001），以及在标准风险（SR，P=0.0003）和高风险（P=0.008）组中，诱导后骨髓细胞中 MRD> = 0.1%是复发的强烈且独立的预测因素。巩固后 MRD 对结果的影响不显著。MRD 状态与传统风险分层系统的结合确定了一个亚组患者，这些患者被分配到 SR 组，MRD 在诱导后<0.1%，3 年的复发风险非常低，为 9%，而其余患者的复发风险为 71%（P=0.001）。我们得出结论，在成人 ALL 的治疗决策中，应在考虑传统风险标准的基础上，评估诱导后 MRD 的评估。