Second Medical Department, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany.
Blood. 2010 Apr 22;115(16):3215-23. doi: 10.1182/blood-2009-06-230250. Epub 2009 Dec 23.
The prognostic impact of minimal residual disease (MRD) was analyzed in 259 patients with mantle cell lymphoma (MCL) treated within 2 randomized trials of the European MCL Network (MCL Younger and MCL Elderly trial). After rituximab-based induction treatment, 106 of 190 evaluable patients (56%) achieved a molecular remission (MR) based on blood and/or bone marrow (BM) analysis. MR resulted in a significantly improved response duration (RD; 87% vs 61% patients in remission at 2 years, P = .004) and emerged to be an independent prognostic factor for RD (hazard ratio = 0.4, 95% confidence interval, 0.1-0.9, P = .028). MR was highly predictive for prolonged RD independent of clinical response (complete response [CR], complete response unconfirmed [CRu], partial response [PR]; RD at 2 years: 94% in BM MRD-negative CR/CRu and 100% in BM MRD-negative PR, compared with 71% in BM MRD-positive CR/CRu and 51% in BM MRD-positive PR, P = .002). Sustained MR during the postinduction period was predictive for outcome in MCL Younger after autologous stem cell transplantation (ASCT; RD at 2 years 100% vs 65%, P = .001) and during maintenance in MCL Elderly (RD at 2 years: 76% vs 36%, P = .015). ASCT increased the proportion of patients in MR from 55% before high-dose therapy to 72% thereafter. Sequential MRD monitoring is a powerful predictor for treatment outcome in MCL. These trials are registered at www.clinicaltrials.gov as #NCT00209222 and #NCT00209209.
在欧洲 MCL 网络（MCL 年轻和 MCL 老年试验）的 2 项随机试验中，对 259 例套细胞淋巴瘤（MCL）患者进行了最小残留疾病（MRD）的预后分析。在基于利妥昔单抗的诱导治疗后，190 例可评估患者中有 106 例（56%）达到了基于血液和/或骨髓（BM）分析的分子缓解（MR）。MR 导致反应持续时间（RD）显著改善（2 年时缓解的患者分别为 87%和 61%，P =.004），并且是 RD 的独立预后因素（风险比= 0.4，95%置信区间，0.1-0.9，P =.028）。MR 是 RD 的高度预测指标，与临床反应无关（完全缓解[CR]，不完全缓解[CRu]，部分缓解[PR]；2 年 RD：BM MRD 阴性 CR/CRu 中为 94%，BM MRD 阴性 PR 中为 100%，而 BM MRD 阳性 CR/CRu 中为 71%，BM MRD 阳性 PR 中为 51%，P =.002）。在自体干细胞移植（ASCT）后，诱导期后持续的 MR 可预测 MCL 年轻患者的结局（2 年 RD 100% vs 65%，P =.001），在 MCL 老年患者的维持治疗中也可预测结局（2 年 RD：76% vs 36%，P =.015）。ASCT 使接受高剂量治疗后达到 MR 的患者比例从 55%增加到 72%。连续监测 MRD 是 MCL 治疗结果的有力预测指标。这些试验在 www.clinicaltrials.gov 上注册为 #NCT00209222 和 #NCT00209209。
