Benton Christopher B, Ravandi Farhad
Department of Leukemia, University of Texas MD Anderson Cancer Center, Houston, Texas.
Clin Adv Hematol Oncol. 2017 Nov;15(11):859-867.
Advances in detecting traces of leukemia that were previously unidentifiable have increasingly led to the incorporation of information about residual disease into clinical decision making for patients with leukemia in both the postinduction and consolidation settings. This review discusses current concepts related to minimal residual disease (MRD), which is defined as submicroscopic disease detected during morphologic complete remission. The focus is on acute myeloid leukemia (AML). Basic methods for detecting MRD include flow cytometry, reverse transcription-polymerase chain reaction, and mutation analysis. Several studies using these assays have demonstrated prognostic implications based on MRD-positive vs MRD-negative status. As our understanding of the biological factors responsible for MRD in AML evolves, residual disease should be evaluated in the context of other prognostic markers. Current therapeutic options for managing MRD in AML are limited, and the clinical implications of a positive MRD test result can be significant. Regarding individual patients, an evidence-based approach must be applied while the institution- and assay-specific differences that currently exist are considered. Challenges associated with MRD assessment, such as the limited standardization of available assays and the paucity of effective agents to eradicate MRD, will need to be overcome before physicians who treat leukemia can use MRD as a tool for clinical management.
在检测先前无法识别的白血病痕迹方面取得的进展，越来越多地促使将残留疾病信息纳入白血病患者诱导缓解期和巩固期的临床决策中。本综述讨论了与微小残留病（MRD）相关的当前概念，微小残留病定义为在形态学完全缓解期间检测到的亚微观疾病。重点是急性髓系白血病（AML）。检测MRD的基本方法包括流式细胞术、逆转录聚合酶链反应和突变分析。几项使用这些检测方法的研究已经证明了基于MRD阳性与MRD阴性状态的预后意义。随着我们对AML中导致MRD的生物学因素的理解不断发展，残留疾病应在其他预后标志物的背景下进行评估。目前AML中管理MRD的治疗选择有限，MRD检测结果阳性的临床意义可能很大。对于个体患者，在考虑当前存在的机构和检测方法特异性差异的同时，必须采用基于证据的方法。在治疗白血病医生能够将MRD用作临床管理工具之前，需要克服与MRD评估相关的挑战，例如现有检测方法标准化有限以及根除MRD的有效药物匮乏。
