Umeda Katsutsugu, Hiramatsu Hidefumi, Kawaguchi Koji, Iwai Atsushi, Mikami Masamitsu, Nodomi Seishiro, Saida Satoshi, Heike Toshio, Ohomori Katsuyuki, Adachi Souichi
Department of Pediatrics, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
Department of Clinical Laboratory, Kyoto University Hospital, Kyoto, Japan.
Pediatr Transplant. 2016 Aug;20(5):692-6. doi: 10.1111/petr.12732. Epub 2016 Jun 3.
There are few reports on the clinical significance of MRD before HSCT in pediatric ALL. We retrospectively analyzed the clinical significance of FCM-based detection of MRD (FCM-MRD) before allogeneic HSCT in pediatric ALL. Of 38 pediatric patients who underwent allogeneic HSCT for the first time between 1998 and 2014, 33 patients were in CR and five patients were in non-CR. The CR group was further divided into two groups based on the pretransplant FCM-MRD level: the MRD(neg) (<0.01%; 30 patients) group and the MRD(pos) (≥0.01%; three patients) group. There were significant differences in the three-yr event-free survival rates between the CR and non-CR group, and between the MRD(neg) and MRD(pos) group. The three-yr cumulative RI in the MRD(neg) group were 27.3% ± 8.8%, whereas two of the three patients in the MRD(pos) group relapsed within one yr after HSCT. The clinical outcome of the MRD(pos) group was as poor as that of the non-CR group in pediatric ALL. Therefore, an improvement in pretransplant treatment that aims to achieve a more profound remission would contribute to reducing the risk of relapse.
关于小儿急性淋巴细胞白血病（ALL）异基因造血干细胞移植（HSCT）前微小残留病（MRD）的临床意义的报道较少。我们回顾性分析了基于流式细胞术（FCM）检测小儿ALL异基因HSCT前MRD（FCM-MRD）的临床意义。在1998年至2014年间首次接受异基因HSCT的38例小儿患者中，33例处于完全缓解（CR）期，5例处于非CR期。CR组根据移植前FCM-MRD水平进一步分为两组：MRD（阴性）（<0.01%；30例患者）组和MRD（阳性）（≥0.01%；3例患者）组。CR组与非CR组之间以及MRD（阴性）组与MRD（阳性）组之间的3年无事件生存率存在显著差异。MRD（阴性）组的3年累积复发率为27.3%±8.8%，而MRD（阳性）组的3例患者中有2例在HSCT后1年内复发。在小儿ALL中，MRD（阳性）组的临床结局与非CR组一样差。因此，旨在实现更深度缓解的移植前治疗的改善将有助于降低复发风险。
