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流式细胞术在细胞减少期检测 AML 微小残留病可识别复发风险增加的患者。

Early assessment of minimal residual disease in AML by flow cytometry during aplasia identifies patients at increased risk of relapse.

机构信息

Department of Internal Medicine III, University of Munich, Munich, Germany.

1] Department of Internal Medicine III, University of Munich, Munich, Germany [2] Institute of Medical Informatics, Biometry and Epidemiology (IBE), University of Munich, Munich, Germany.

出版信息

Leukemia. 2015 Feb;29(2):377-86. doi: 10.1038/leu.2014.186. Epub 2014 Jun 10.

Abstract

In acute myeloid leukemia (AML), assessment of minimal residual disease (MRD) by flow cytometry (flow MRD) after induction and consolidation therapy has been shown to provide independent prognostic information. However, data on the value of earlier flow MRD assessment are lacking. Therefore, the value of flow MRD detection was determined during aplasia in 178 patients achieving complete remission after treatment according to AMLCG (AML Cooperative Group) induction protocols. Flow MRD positivity during aplasia predicted poor outcome (5-year relapse-free survival (RFS) 16% vs 43%, P<0.001) independently from age and cytogenetic risk group (hazard ratio for MRD positivity 1.71; P=0.009). Importantly, the prognosis of patients without detectable MRD was neither impacted by morphological blast count during aplasia nor by MRD status postinduction. Early flow MRD was also evaluated in the context of existing risk factors. Flow MRD was prognostic within the intermediate cytogenetic risk group (5-year RFS 15% vs 37%, P=0.016) as well as for patients with normal karyotype and NPM1 mutations (5-year RFS 13% vs 49%, P=0.02) or FLT3-ITD (3-year RFS rates 9% vs 44%, P=0.016). Early flow MRD assessment can improve current risk stratification approaches by prediction of RFS in AML and might facilitate adaptation of postremission therapy for patients at high risk of relapse.

摘要

在急性髓系白血病(AML)中,诱导和巩固治疗后通过流式细胞术(流式 MRD)评估微小残留病(MRD)已被证明提供了独立的预后信息。然而,缺乏关于更早的流式 MRD 评估价值的数据。因此,在根据 AMLCG(AML 合作组)诱导方案达到完全缓解的 178 例患者的缓解期确定了流式 MRD 检测的价值。缓解期的流式 MRD 阳性独立于年龄和细胞遗传学危险组预测不良预后(5 年无复发生存率(RFS)分别为 16%和 43%,P<0.001)(MRD 阳性的危险比为 1.71;P=0.009)。重要的是,在缓解期无形态学 blast 计数和诱导后 MRD 状态的情况下,无可检测到的 MRD 的患者的预后不受影响。早期流式 MRD 也在现有危险因素的背景下进行了评估。在中间细胞遗传学危险组中,流式 MRD 具有预后意义(5 年 RFS 分别为 15%和 37%,P=0.016),以及对于正常核型和 NPM1 突变的患者(5 年 RFS 分别为 13%和 49%,P=0.02)或 FLT3-ITD(3 年 RFS 率分别为 9%和 44%,P=0.016)。早期流式 MRD 评估可以通过预测 AML 的 RFS 来改善当前的风险分层方法,并可能为高复发风险的患者适应缓解后治疗。

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