Department of Biopatologia e Diagnostica per Immagini, Fondazione Policlinico Tor Vergata and Ospedale S.Eugenio, Rome, Italy.
Curr Opin Oncol. 2009 Nov;21(6):582-8. doi: 10.1097/CCO.0b013e3283311856.
In acute myeloid leukemia, minimal residual disease (MRD) detection is recognized as a critical diagnostic tool to assess the quality of response after induction therapy and to outline postremissional programs based on the individual risk of relapse. The most popular methods to investigate MRD are multiparametric flow cytometry (MPFC) and polymerase chain reaction, since these techniques have proven sensitive and specific enough to allow MRD to be studied serially. In the present review we will focus on the use of MPFC for monitoring of MRD, addressing the main technical and clinical issues.
Lack of standardization among different laboratories, immunophenotypic stability, identifications of thresholds and time-points during follow-up represent the major subjects of confrontation whose definitive solution might rely on the application of new technologies and dedicated statistical approaches.
Studies of MRD should provide us the opportunity to generate comprehensive prognostic algorithms which take into account conventional parameters, such as cytogenetic and genetic profile, and those strictly inherent to the quality of response, such as determination of residual leukemia. This will greatly enhance development of personalized therapeutic approaches, avoiding the situation of under or over drug exposure.
在急性髓系白血病中，微小残留病灶 (MRD) 检测被认为是评估诱导治疗后反应质量的关键诊断工具，并根据个体复发风险制定缓解后方案。目前最流行的 MRD 检测方法是多参数流式细胞术 (MPFC) 和聚合酶链反应，因为这些技术已被证明足够灵敏和特异，能够进行连续的 MRD 研究。在本综述中，我们将重点关注 MPFC 在监测 MRD 中的应用，讨论主要的技术和临床问题。
不同实验室之间缺乏标准化、免疫表型稳定性、确定阈值和随访期间的时间点，这些都是主要的争议点，其最终解决可能依赖于新技术和专用统计方法的应用。
MRD 的研究应该为我们提供机会，制定全面的预后算法，这些算法将考虑传统参数，如细胞遗传学和遗传学特征，以及与反应质量直接相关的参数，如残留白血病的确定。这将极大地促进个体化治疗方法的发展，避免药物暴露不足或过度的情况。
