Luskin Marlise R, Stone Richard M
Dana-Farber Cancer Institute; and Harvard Medical School, Boston, MA.
J Oncol Pract. 2017 Aug;13(8):471-480. doi: 10.1200/JOP.2017.021675.
In acute myeloid leukemia (AML) that is in complete remission, minimal residual disease (MRD) is presumed to be present, though not morphologically evident. Advances in diagnostics now permit the detection and quantification of MRD in AML by several techniques. The level of MRD after induction and consolidation therapy correlates with disease sensitivity to chemotherapy and has greater power to predict long-term survival than patient and disease characteristics that are available at diagnosis, including genetic information. A unique advantage of MRD is that it is an integrated measure of the impact and interaction of genetics, epigenetics, host immune milieu, bone marrow environment, and drug sensitivity on disease response to treatment. Here, we review the main techniques for MRD assessment in AML, including polymerase chain reaction, multiparameter flow cytometry, and next-generation sequencing, with a focus on method-specific and general limitations to the optimal employment of MRD techniques for the determination of AML prognosis. We also review the data that establish the prognostic and predictive value of MRD assessment in AML. Finally, we provide recommendations for the use of MRD in the care of patients with AML in clinical practice today, including whether it should influence treatment decisions.
在处于完全缓解期的急性髓系白血病（AML）中，尽管形态学上不明显，但推测存在微小残留病（MRD）。目前诊断技术的进步使得通过多种技术能够检测和定量AML中的MRD。诱导和巩固治疗后的MRD水平与疾病对化疗的敏感性相关，并且比诊断时可用的患者和疾病特征（包括遗传信息）更能预测长期生存。MRD的一个独特优势在于，它是对遗传学、表观遗传学、宿主免疫环境、骨髓环境以及药物敏感性对疾病治疗反应的影响和相互作用的综合衡量。在此，我们综述AML中MRD评估的主要技术，包括聚合酶链反应、多参数流式细胞术和下一代测序，重点关注MRD技术在确定AML预后时的方法特异性和一般局限性。我们还综述了确立AML中MRD评估的预后和预测价值的数据。最后，我们针对目前临床实践中AML患者护理中MRD的使用提供建议，包括其是否应影响治疗决策。
