Laboratorio de Citometría de Flujo, Servicio de Hematología y Hemoterapia, Hospital Universitario de Getafe, Getafe, Madrid, España.
Laboratorio de Genética Molecular, Servicio de Hematología y Hemoterapia, Hospital Universitario Puerta de Hierro, Madrid, España.
Med Clin (Barc). 2018 Feb 23;150(4):144-149. doi: 10.1016/j.medcli.2017.06.067. Epub 2017 Aug 31.
Minimal residual disease (MRD) assessment is an important endpoint in the treatment of chronic lymphocytic leukaemia (CLL). It is highly predictive of prolonged progression-free survival (PFS) and overall survival and could be considered a surrogate for PFS in the context of chemoimmunotherapy based treatment. Evaluation of MRD level by flow cytometry or molecular techniques in the era of the new BCR and Bcl-2 targeted inhibitors could identify the most cost-effective and durable treatment sequencing. A therapeutic approach guided by the level of MRD might also determine which patients would benefit from an early stop or consolidation therapy. In this review, we discuss the different MRD methods of analysis, which source of tumour samples must be analysed, the future role of the detection of circulating tumour DNA, and the potential role of MRD negativity in clinical practice in the modern era of CLL therapy.
微小残留病灶（MRD）评估是慢性淋巴细胞白血病（CLL）治疗的一个重要终点。它高度预测无进展生存期（PFS）和总生存期，并且可以在基于化疗免疫治疗的情况下被视为 PFS 的替代指标。在新型 BCR 和 Bcl-2 靶向抑制剂时代，通过流式细胞术或分子技术评估 MRD 水平可以确定最具成本效益和持久的治疗方案。基于 MRD 水平的治疗方法也可能确定哪些患者将受益于早期停止或巩固治疗。在这篇综述中，我们讨论了不同的 MRD 分析方法、必须分析的肿瘤样本来源、循环肿瘤 DNA 检测的未来作用，以及在 CLL 治疗的现代时代，MRD 阴性在临床实践中的潜在作用。
