Buccisano Francesco, Dillon Richard, Freeman Sylvie D, Venditti Adriano
Hematology, Department of Biomedicine and Prevention, Tor Vergata University of Rome, 00133 Rome, Italy.
Department of Medical and Molecular Genetics, King's College, London SE1 9RT, UK.
Cancers (Basel). 2018 Jun 26;10(7):215. doi: 10.3390/cancers10070215.
Minimal (or measurable) residual (MRD) disease provides a biomarker of response quality for which there is robust validation in the context of modern intensive treatment for younger patients with Acute Myeloid Leukemia (AML). Nevertheless, it remains a relatively unexplored area in older patients with AML. The lack of progress in this field can be attributed to two main reasons. First, physicians have a general reluctance to submitting older adults to intensive chemotherapy due to their frailty and to the unfavourable biological disease profile predicting a poor outcome following conventional chemotherapy. Second, with the increasing use of low-intensity therapies (i.e., hypomethylating agents) differing from conventional drugs in mechanism of action and dynamics of response, there has been concomitant skepticism that these schedules can produce deep hematological responses. Furthermore, age dependent differences in disease biology also contribute to uncertainty on the prognostic/predictive impact in older adults of certain genetic abnormalities including those validated for MRD monitoring in younger patients. This review examines the evidence for the role of MRD as a prognosticator in older AML, together with the possible pitfalls of MRD evaluation in older age.
微小（或可测量）残留（MRD）疾病为反应质量提供了一种生物标志物，在对年轻急性髓系白血病（AML）患者进行现代强化治疗的背景下，对此有充分的验证。然而，在老年AML患者中，这仍然是一个相对未被探索的领域。该领域缺乏进展可归因于两个主要原因。首先，由于老年患者身体虚弱以及不利的生物学疾病特征预示着传统化疗后预后不良，医生普遍不愿让老年人接受强化化疗。其次，随着低强度疗法（即去甲基化药物）的使用增加，这些疗法在作用机制和反应动态方面与传统药物不同，人们随之怀疑这些方案能否产生深度血液学反应。此外，疾病生物学方面的年龄依赖性差异也导致对于某些基因异常在老年患者中的预后/预测影响存在不确定性，这些基因异常在年轻患者中已被验证可用于MRD监测。本综述探讨了MRD作为老年AML预后指标的作用证据，以及老年患者中MRD评估可能存在的陷阱。
