Peking University People's Hospital & Peking University Institute of Hematology, Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, Beijing, China.
Ann Hematol. 2013 Aug;92(8):1111-9. doi: 10.1007/s00277-013-1733-1. Epub 2013 May 17.
Either WT1 or leukemia-associated aberrant immune phenotypes (LAIPs) was one of the minimal residual disease (MRD) parameters used to predict leukemia relapse after allogeneic hematopoietic stem cell transplantation (allo-HSCT). We first evaluated the clinical value of various positive MRD standards for accurately indicating relapse based on WT1 and FCM data in adult patients with acute leukemia (AL). In total, 824 AL patients treated with allo-HSCT were enrolled in this study. We compared the sensitivity and specificity of diverse, multiple-criteria MRD prognostic standards based on WT1 and FCM assays. Higher sensitivity was achieved without a loss of specificity when MRDco+, which was defined as two consecutive WT10.6+ or FCM+ or both WT10.6+ and FCM+ in the same sample within a year posttransplantation, was used as the positive MRD standard. Similar results were observed, even in 484 patients who had both abnormal WT1 and LAIPs values before transplant. A multivariate analysis showed that MRDco+ was an independent risk factor for leukemia relapse after transplant in both acute myeloid leukemia (AML) and acute lymphoblastic leukemia (ALL). The combined use of FCM and WT1 monitoring could distinguish between patients with low and high risks of relapse. Various positive MRD standards were useful for guiding intervention.
无论是 WT1 还是白血病相关异常免疫表型（LAIPs），都是异基因造血干细胞移植（allo-HSCT）后预测白血病复发的微小残留病（MRD）参数之一。我们首先基于 WT1 和 FCM 数据，评估了各种阳性 MRD 标准在成人急性白血病（AL）患者中准确预测复发的临床价值。本研究共纳入 824 例接受 allo-HSCT 治疗的 AL 患者。我们比较了基于 WT1 和 FCM 检测的多种多标准 MRD 预后标准的敏感性和特异性。当将 MRDco+定义为移植后一年内同一样本中连续两次 WT10.6+或 FCM+或两者均为阳性时，作为阳性 MRD 标准，可在不降低特异性的情况下提高敏感性。在 484 例移植前 WT1 和 LAIPs 值均异常的患者中，也观察到了类似的结果。多变量分析显示，MRDco+是移植后 AML 和 ALL 患者白血病复发的独立危险因素。FCM 和 WT1 联合监测可区分复发风险低和高的患者。各种阳性 MRD 标准可用于指导干预。
