Peking University People's Hospital, Peking University Institute of Hematology, No 11 Xizhimen South Street, Beijing, 100044, People's Republic of China.
Ann Hematol. 2012 Feb;91(2):183-92. doi: 10.1007/s00277-011-1285-1. Epub 2011 Jun 28.
This study evaluated the prognostic value of minimal residual disease (MRD) monitoring by four-color flow cytometry (FCM) in patients with acute lymphoblastic leukemia (ALL) undergoing allogeneic hematopoietic stem cell transplantation (allo-HSCT). MRD was examined with four-color FCM at different time points in 139 patients (including pediatric and adult patients) with ALL after allo-HSCT. Real-time quantitative polymerase chain reaction (RQ-PCR) was applied to evaluate the MRD of Philadelphia chromosome-positive ALL (Ph+ ALL) patients. Patients who were FCM-positive (FCM+) after transplantation had a lower event-free survival (EFS) of 0.54 and a higher cumulative incidence of relapse (CIR) of 0.54 compared to an EFS of 0.80 and a CIR of 0.08 in FCM-negative (FCM-) patients (EFS, p < 0.001; CIR, p < 0.001). Similar results were obtained in high-risk patients and Ph+ ALL patients. Moreover, a FCM+ status after the second month post-HSCT (defined as MRD positive) proved to be a predictor of leukemia relapse. Multivariate analysis for EFS, OS and CIR showed that MRD status after transplantation was an independent prognostic factor (p < 0.001, p = 0.013, and p < 0.001, respectively). A good correlation was found between the MRD results of FCM and RQ-PCR (n = 126 pairs, Spearman r = 0.8139, p < 0.001). MRD monitoring by four-color FCM post-transplantation is an important tool for relapse prediction in ALL patients. Prompt and appropriate pre-emptive anti-leukemia treatment could be considered based on the status of MRD after HSCT.
这项研究评估了四色流式细胞术（FCM）在接受异基因造血干细胞移植（allo-HSCT）的急性淋巴细胞白血病（ALL）患者中监测微小残留病（MRD）的预后价值。在 139 例（包括儿科和成人患者）allo-HSCT 后 ALL 患者的不同时间点，采用四色 FCM 检测 MRD。实时定量聚合酶链反应（RQ-PCR）用于评估费城染色体阳性 ALL（Ph+ ALL）患者的 MRD。移植后 FCM 阳性（FCM+）的患者无事件生存（EFS）为 0.54，累积复发率（CIR）为 0.54，而 FCM 阴性（FCM-）患者的 EFS 为 0.80，CIR 为 0.08（EFS，p < 0.001；CIR，p < 0.001）。高危患者和 Ph+ ALL 患者也得到了类似的结果。此外，HSCT 后第二个月的 FCM+状态（定义为 MRD 阳性）被证明是白血病复发的预测因素。EFS、OS 和 CIR 的多变量分析显示，移植后 MRD 状态是独立的预后因素（p < 0.001、p = 0.013 和 p < 0.001）。FCM 和 RQ-PCR 的 MRD 结果之间存在良好的相关性（n = 126 对，Spearman r = 0.8139，p < 0.001）。移植后四色 FCM 监测是预测 ALL 患者复发的重要工具。根据 HSCT 后 MRD 的状态，可以考虑进行及时和适当的预防性抗白血病治疗。
