Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
Br J Haematol. 2013 Jul;162(2):147-61. doi: 10.1111/bjh.12358. Epub 2013 May 9.
In patients with acute leukaemia, the relative risk of relapse influences the choice between chemotherapy and haematopoietic stem cell transplantation (HSCT). The demonstration that minimal residual disease (MRD) is the strongest overall prognostic indicator and can identify patients who are unlikely to be cured by standard chemotherapy has added a powerful new factor to consider when making this decision. There is substantial data indicating that the likelihood of relapse after transplant is directly correlated with levels of MRD before transplant. This knowledge can be used to adjust the timing of HSCT, and guide the selection of donor, conditioning regimen, and post-HSCT strategies to maximize the graft-versus-leukaemia effect. Because MRD emerging post-transplant carries a dire prognosis, its detection can trigger withdrawal of immunosuppression, additional cellular and molecular therapies, or preparations for a second HSCT. Although it is not yet clear whether any of these actions will significantly improve outcome, it is likely that they will be most effective for patients with a relatively low tumour burden, who can be identified only through MRD testing. In this article, we review the clinical significance of MRD in the context of autologous and allogeneic HSCT.
在急性白血病患者中，复发的相对风险影响着化疗和造血干细胞移植（HSCT）之间的选择。已经证明，微小残留病（MRD）是最强的总体预后指标，可以识别出那些不太可能通过标准化疗治愈的患者，这为做出这一决策增加了一个强有力的新因素。有大量数据表明，移植后复发的可能性与移植前的 MRD 水平直接相关。这些知识可用于调整 HSCT 的时机，并指导供体选择、预处理方案和移植后策略，以最大限度地发挥移植物抗白血病效应。由于移植后出现的 MRD 具有严重的预后，其检测可以触发免疫抑制药物的停药、额外的细胞和分子治疗，或准备进行第二次 HSCT。虽然目前尚不清楚这些措施中的任何一项是否会显著改善预后，但它们很可能对肿瘤负担相对较低的患者最有效，而这些患者只能通过 MRD 检测来识别。在本文中，我们将回顾 MRD 在自体和同种异体 HSCT 背景下的临床意义。
