Chen Xueyan, Wood Brent L
Department of Laboratory Medicine, University of Washington, Seattle, WA, USA.
Department of Laboratory Medicine, University of Washington, Seattle, WA, USA; Seattle Cancer Care Alliance, Seattle, WA, USA.
Best Pract Res Clin Haematol. 2017 Sep;30(3):237-248. doi: 10.1016/j.beha.2017.07.002. Epub 2017 Jul 6.
Minimal residual disease (MRD) is the most significant independent prognostic factor in acute lymphocytic leukemia (ALL). Monitoring MRD using sensitive techniques, including multiparametric flow cytometry (MFC) and quantitative polymerase chain reaction (qPCR)-based methods, has improved the assessment of treatment response and risk stratification for clinical management. New molecular methods, such as high-throughput next-generation sequencing (NGS), have evolved into routine laboratory tools to improve the sensitivity and specificity of MRD detection. It is essential to establish standardized protocols as to the timing of assessment and methodology used, to limit inter-laboratory variability. MRD has demonstrated utility for the identification of patients with suboptimal initial response to therapy who may benefit from more intensive or novel therapies, in addition to identifying patients with an excellent response to initial therapy who may be candidates for therapeutic reduction to limit toxicity. Herein, we review the methodological approaches to MRD detection in ALL and discuss the clinical implication of MRD in risk-directed therapy and practical issues.
微小残留病（MRD）是急性淋巴细胞白血病（ALL）中最重要的独立预后因素。使用包括多参数流式细胞术（MFC）和基于定量聚合酶链反应（qPCR）的方法在内的敏感技术监测MRD，改善了对治疗反应的评估以及临床管理中的风险分层。新的分子方法，如高通量下一代测序（NGS），已发展成为常规实验室工具，以提高MRD检测的灵敏度和特异性。建立关于评估时间和所用方法的标准化方案至关重要，以限制实验室间的变异性。MRD已证明可用于识别对初始治疗反应欠佳的患者，这些患者可能从更强化或新型疗法中获益，此外还可识别对初始治疗反应良好的患者，这些患者可能是减少治疗以限制毒性的候选者。在此，我们综述了ALL中MRD检测的方法学途径，并讨论了MRD在风险导向治疗中的临床意义及实际问题。
