Leukemia Clinic, Department of Hematology and Oncology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Avenida Vasco de Quiroga No. 15, Colonia Belisario Domínguez Sección XVI, Delegación Tlalpan, 14080, Mexico City, CP, Mexico.
Curr Oncol Rep. 2018 Mar 26;20(4):36. doi: 10.1007/s11912-018-0679-9.
The purpose of this review is to discuss the potential role of allogeneic hematopoietic stem cell transplantation (allo-HSCT) for Philadelphia-negative (Ph) adult acute lymphoblastic leukemia (ALL) in first complete remission (CR1) in the era of minimal residual disease (MRD).
Allo-HSCT continues to have a role in the therapy of a selected group of high-risk adult patients with ALL in CR1. Although the clinical significance of MRD has been studied less extensively in adults with ALL than in children, recent studies support its role as the strongest prognostic factor that can identify patients that are unlikely to be cured by standard chemotherapy and benefit from undergoing allo-HSCT. In addition, MRD status both pre- and post-HSCT has been found to correlate directly with the risk of relapse. Currently, the clinical challenge consists on applying MRD and molecular failure to integrate novel agents and immunotherapy to lower MRD before allo-HSCT and to modulate the graft versus leukemia (GVL) effect after transplant.
本综述旨在讨论微小残留病灶（MRD）时代，在完全缓解 1 期（CR1）时异体造血干细胞移植（allo-HSCT）对费城染色体阴性（Ph）成人急性淋巴细胞白血病（ALL）的潜在作用。
allo-HSCT 在治疗选择的高危成人 ALL 患者 CR1 中仍具有作用。尽管 MRD 在成人 ALL 中的临床意义不如在儿童中广泛研究，但最近的研究支持其作为最强的预后因素，可以识别出那些不太可能通过标准化疗治愈并受益于 allo-HSCT 的患者。此外，移植前和移植后的 MRD 状态均与复发风险直接相关。目前，临床挑战在于应用 MRD 和分子失败来整合新的药物和免疫疗法，在 allo-HSCT 前降低 MRD，并在移植后调节移植物抗白血病（GVL）效应。
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