Gritti Giuseppe, Pavoni Chiara, Rambaldi Alessandro
Hematology and Bone Marrow Transplant Unit, Ospedale Papa Giovanni XXIII, Bergamo, Italy.
Hematology and Bone Marrow Transplant Unit, Ospedale Papa Giovanni XXIII, Bergamo, Italy; Department of Oncology and Oncohematology, Università degli Studi di Milano, Milano, Italy.
Mediterr J Hematol Infect Dis. 2017 Jan 1;9(1):e2017010. doi: 10.4084/MJHID.2017.010. eCollection 2017.
After 25 years, evaluation of minimal residual disease (MRD) in follicular lymphoma (FL) has become a standardized technique frequently integrated into clinical trials for its consistent and independent prognostic significance. Achievement of a sustained MRD negativity is a marker of treatment sensibility that has been associated with excellent clinical outcome in terms of clinical response and progression-free survival, independently from the employed therapy. However, no survival advantages has been reported for MRD negative patients and despite the compelling results of clinical trials, MRD evaluation has currently no role in clinical practice. Ongoing clinical trials will help in clarifying the potential setting in which MRD monitoring may have a routine clinical application i.e. allowing de-escalation of standard maintenance therapy in very low risk patients. In this review the clinical implications of MRD monitoring in Rituximab-era are discussed in light of the current treatment paradigms most aimed at reducing toxicities, and the response definition that now routinely integrates PET scan.
25年来，滤泡性淋巴瘤（FL）微小残留病（MRD）评估已成为一项标准化技术，因其具有一致且独立的预后意义，常被纳入临床试验。实现持续的MRD阴性是治疗敏感性的标志，在临床反应和无进展生存期方面，与良好的临床结果相关，且与所采用的治疗方法无关。然而，尚未有报道称MRD阴性患者具有生存优势，尽管临床试验结果令人信服，但目前MRD评估在临床实践中并无作用。正在进行的临床试验将有助于明确MRD监测可能具有常规临床应用的潜在情况，即允许在极低风险患者中降低标准维持治疗的强度。在本综述中，根据当前最旨在降低毒性的治疗模式以及现在常规纳入PET扫描的反应定义，讨论了利妥昔单抗时代MRD监测的临床意义。
