Department of Bone Marrow Transplantation and Cellular Therapy, St Jude Children's Research Hospital, 262 Danny Thomas Pl, Memphis, TN 38105-2794, USA.
Blood. 2012 Jul 12;120(2):468-72. doi: 10.1182/blood-2012-02-409813. Epub 2012 Apr 19.
In patients with acute leukemia, detection of minimal residual disease (MRD) before allogeneic hematopoietic cell transplantation (HCT) correlates with risk of relapse. However, the level of MRD that is most likely to preclude cure by HCT is unclear, and the benefit of further chemotherapy to reduce MRD before HCT is unknown. In 122 children with very-high-risk acute lymphoblastic leukemia (ALL; n = 64) or acute myeloid leukemia (AML, n = 58), higher MRD levels at the time of HCT predicted a poorer survival after HCT (P = .0019); MRD was an independent prognostic factor in a multivariate analysis (P = .0035). However, the increase in risk of death associated with a similar increment of MRD was greater in ALL than in AML, suggesting that a pretransplantation reduction of leukemia burden would have a higher impact in ALL. At any given MRD level, survival rates were higher for patients treated in recent protocols: the 5-year overall survival for patients with ALL was 49% if MRD was detectable and 88% if it was not and the corresponding rates for patients with AML were 67% and 80%, respectively. Although MRD before HCT is a strong prognostic factor, its impact has diminished and should not be regarded as a contraindication for HCT.
在急性白血病患者中，异基因造血细胞移植（HCT）前微小残留病（MRD）的检测与复发风险相关。然而，最有可能通过 HCT 治愈的 MRD 水平尚不清楚，HCT 前进一步化疗以降低 MRD 的益处也尚不清楚。在 122 例极高危急性淋巴细胞白血病（ALL；n = 64）或急性髓细胞白血病（AML，n = 58）患儿中，HCT 时更高的 MRD 水平预测 HCT 后生存较差（P =.0019）；在多变量分析中，MRD 是一个独立的预后因素（P =.0035）。然而，与类似增量的 MRD 相关的死亡风险增加在 ALL 中比在 AML 中更大，这表明在移植前降低白血病负担将对 ALL 产生更高的影响。在任何给定的 MRD 水平下，接受最近方案治疗的患者生存率更高：ALL 患者的 5 年总生存率为 49%（如果可检测到 MRD）和 88%（如果不可检测到 MRD），相应的 AML 患者的生存率分别为 67%和 80%。虽然 HCT 前的 MRD 是一个强有力的预后因素，但它的影响已经减弱，不应该被视为 HCT 的禁忌症。
