Peking University People's Hospital & Peking University Institute of Hematology, Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, Beijing, People's Republic of China.
National Clinical Research Center for Hematologic Disease, Beijing, People's Republic of China.
Cytometry B Clin Cytom. 2020 Jan;98(1):75-87. doi: 10.1002/cyto.b.21840. Epub 2019 Aug 19.
This study aimed to determine the impact of the pre- and post-minimal residual disease (MRD) status as well as the peri-transplant MRD kinetics on clinical outcomes in pediatric ALL patients who received haploidentical allografts.
A retrospective study (n = 166) was performed. MRD was determined using multiparameter flow cytometry.
Pediatric ALL patients with pre-MRDneg had a lower cumulative incidences of relapse (CIR) compared to those with pre-MRDpos (19.7% vs. 41.2%, P = 0.009). Compared to post-MRDneg group, patients with post-MRDpos experienced higher CIR (81.0% vs. 15.9%, P < 0.001), inferior LFS (14.3% vs. 66.9%, P < 0.001) and OS (19.1% vs. 66.9%, P < 0.001). In regard to peri-MRD kinetics, compared with the MRD-decreasing group and MRDneg/MRDneg group, MRD-increasing group had higher CIR, lower probabilities of LFS and OS (P < 0.001). Compared to pre-MRDneg/post-MRDneg group, a higher CIR was found in the pre-MRDpos/post-MRDpos group (66.7% vs. 12.5%, P < 0.001), pre-MRDpos/post-MRDneg group (32.0% vs. 12.5%, P = 0.016), and pre-MRDneg/post-MRDpos group (91.7% vs. 12.5%, P < 0.001). A lower incidence of LFS and OS were found in pre-MRDpos/post-MRDpos group and pre-MRDneg/post-MRDpos group than in pre-MRDneg/post-MRDneg group (P < 0.05). Multivariate analyses confirmed the association of pre-MRD status, post-MRD status, and peri-MRD kinetics with outcomes (P < 0.05).
The results indicate that, in the pediatric ALL subgroup, not only pre-MRD status or post-MRD status but also peri-SCT MRD dynamics, were associated with an increased CIR after haploidentical allografts. Patients are put into different risk group based on MRD kinetics versus single time MRD status. © 2019 International Clinical Cytometry Society.
本研究旨在探讨儿童急性淋巴细胞白血病（ALL）患者接受单倍体相合移植后，微小残留病（MRD）的预处理和后处理状态以及移植前 MRD 动力学对临床结果的影响。
回顾性研究（n=166）。采用多参数流式细胞术检测 MRD。
与预处理 MRD 阳性（pre-MRDpos）患者相比，预处理 MRD 阴性（pre-MRDneg）患者的累积复发率（CIR）更低（19.7% vs. 41.2%，P=0.009）。与 post-MRDneg 组相比，post-MRDpos 患者的 CIR 更高（81.0% vs. 15.9%，P<0.001），无事件生存率（EFS）和总生存率（OS）更低（14.3% vs. 66.9%，P<0.001）。在移植前 MRD 动力学方面，与 MRD 降低组和 pre-MRDneg/MRDneg 组相比，MRD 升高组的 CIR 更高，EFS 和 OS 概率更低（P<0.001）。与 pre-MRDneg/post-MRDneg 组相比，pre-MRDpos/post-MRDpos 组的 CIR 更高（66.7% vs. 12.5%，P<0.001），pre-MRDpos/post-MRDneg 组的 CIR 更高（32.0% vs. 12.5%，P=0.016），pre-MRDneg/post-MRDpos 组的 CIR 更高（91.7% vs. 12.5%，P<0.001）。与 pre-MRDneg/post-MRDneg 组相比，pre-MRDpos/post-MRDpos 组和 pre-MRDneg/post-MRDpos 组的 EFS 和 OS 发生率更低（P<0.05）。多变量分析证实了预处理 MRD 状态、post-MRD 状态和移植前 SCT MRD 动力学与预后的相关性（P<0.05）。
结果表明，在儿童 ALL 亚组中，不仅预处理 MRD 状态或 post-MRD 状态，而且移植前 SCT MRD 动力学也与单倍体相合移植后 CIR 增加相关。患者根据 MRD 动力学与单一时间点的 MRD 状态被分为不同的风险组。© 2019 国际临床细胞化学学会。
