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微小残留病灶评估改善慢性淋巴细胞白血病(CLL)患者达部分缓解患者的预后预测:德国 CLL 研究组两项 III 期研究的综合分析。

Minimal Residual Disease Assessment Improves Prediction of Outcome in Patients With Chronic Lymphocytic Leukemia (CLL) Who Achieve Partial Response: Comprehensive Analysis of Two Phase III Studies of the German CLL Study Group.

机构信息

Gabor Kovacs, Sandra Robrecht, Anna Maria Fink, Jasmin Bahlo, Paula Cramer, Julia von Tresckow, Christian Maurer, Petra Langerbeins, Kirsten Fischer, Michael Hallek, and Barbara Eichhorst, University of Cologne and Center of Integrated Oncology Cologne/Bonn, Cologne; Matthias Ritgen, Michael Kneba, and Sebastian Böttcher, University of Schleswig-Holstein, Lubeck; Hartmut Döhner and Stephan Stilgenbauer, University of Ulm, Ulm; Wolfram Klapper, University of Kiel, Kiel; Clemens-Martin Wendtner, Klinikum Schwabing, Munich, Germany; and Günter Fingerle-Rowson, F. Hoffmann La-Roche, Basel, Switzerland.

出版信息

J Clin Oncol. 2016 Nov 1;34(31):3758-3765. doi: 10.1200/JCO.2016.67.1305.

Abstract

Purpose To determine the value of minimal residual disease (MRD) assessments, together with the evaluation of clinical response in chronic lymphocytic leukemia according to the 2008 International Workshop on Chronic Lymphocytic Leukemia criteria. Patients and Methods Progression-free survival (PFS) and overall survival of 554 patients from two randomized trials of the German CLL Study Group (CLL8: fludarabine and cyclophosphamide [FC] v FC plus rituximab; CLL10: FC plus rituximab v bendamustine plus rituximab) were analyzed according to MRD assessed in peripheral blood at a threshold of 10 and clinical response. The prognostic value of different parameters defining a partial response (PR) was further investigated. Results Patients with MRD-negative complete remission (CR), MRD-negative PR, MRD-positive CR, and MRD-positive PR experienced a median PFS from a landmark at end of treatment of 61 months, 54 months, 35 months, and 21 months, respectively. PFS did not differ significantly between MRD-negative CR and MRD-negative PR; however, PFS was longer for MRD-negative PR than for MRD-positive CR ( P = .048) and for MRD-positive CR compared with MRD-positive PR ( P = .002). Compared with MRD-negative CR, only patients with MRD-positive PR had a significantly shorter overall survival (not reached v 72 months; P = .001), whereas there was no detectable difference for patients with MRD-negative PR or MRD-positive CR ( P = 0.612 and P = 0.853, respectively). Patients with MRD-negative PR who presented with residual splenomegaly had only a similar PFS (63 months) compared with patients with MRD-negative CR (61 months; P = .354), whereas patients with MRD-negative PR with lymphadenopathy showed a shorter PFS (31 months; P < .001). Conclusion MRD quantification allows for improved PFS prediction in both patients who achive PR and CR, which thus supports its application in all responders. In contrast to residual lymphadenopathy, persisting splenomegaly does not impact outcome in patients with MRD-negative PR.

摘要

目的 评估微小残留病(MRD)在根据 2008 年国际慢性淋巴细胞白血病研讨会标准评估慢性淋巴细胞白血病患者的临床反应中的价值。

方法 对德国 CLL 研究组两项随机试验(CLL8:氟达拉滨和环磷酰胺[FC]与 FC 加利妥昔单抗;CLL10:FC 加利妥昔单抗与苯达莫司汀加利妥昔单抗)中的 554 例患者的无进展生存期(PFS)和总生存期进行分析,根据外周血中 10 个阈值的 MRD 评估和临床反应。进一步研究了定义部分缓解(PR)的不同参数的预后价值。

结果 完全缓解(CR)时 MRD 阴性、PR 时 MRD 阴性、CR 时 MRD 阳性和 PR 时 MRD 阳性的患者,自治疗结束时的里程碑处的中位 PFS 分别为 61 个月、54 个月、35 个月和 21 个月。MRD 阴性 CR 和 MRD 阴性 PR 之间的 PFS 无显著差异;然而,MRD 阴性 PR 的 PFS 长于 MRD 阳性 CR(P =.048)和 MRD 阳性 CR 与 MRD 阳性 PR 相比(P =.002)。与 MRD 阴性 CR 相比,只有 MRD 阳性 PR 的患者总生存期明显更短(未达到 v 72 个月;P =.001),而 MRD 阴性 PR 或 MRD 阳性 CR 的患者则没有差异(P = 0.612 和 P = 0.853)。有残留脾肿大的 MRD 阴性 PR 患者的 PFS 与 MRD 阴性 CR 患者的 PFS 相似(63 个月)(P =.354),而有淋巴结病的 MRD 阴性 PR 患者的 PFS 较短(31 个月;P <.001)。

结论 在获得 PR 和 CR 的患者中,MRD 定量可提高 PFS 预测的准确性,因此支持在所有应答者中应用。与残留淋巴结病不同,MRD 阴性 PR 患者残留脾肿大不影响结局。

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