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非急性早幼粒细胞白血病急性髓系白血病中可测量残留病的临床挑战与后果

Clinical Challenges and Consequences of Measurable Residual Disease in Non-APL Acute Myeloid Leukemia.

作者信息

Jentzsch Madlen, Schwind Sebastian, Bach Enrica, Stasik Sebastian, Thiede Christian, Platzbecker Uwe

机构信息

Medical Clinic and Policlinic 1, Hematology and Cellular Therapy, Leipzig University Hospital, 04103 Leipzig, Germany.

Medical Department I, University Hospital and Faculty of Medicine, TU Dresden, 01307 Dresden, Germany.

出版信息

Cancers (Basel). 2019 Oct 23;11(11):1625. doi: 10.3390/cancers11111625.

Abstract

The ability to detect residual levels of leukemic blasts (measurable residual disease, MRD) has already been integrated in the daily routine for treatment of patients with chronic myeloid and acute lymphoblastic leukemia. In acute myeloid leukemia (AML), a variety of mostly retrospective studies have shown that individuals in AML remission who tested positive for MRD at specific time-points or had increasing MRD levels are at significantly higher risk of relapse and death compared to MRD-negative patients. However, these studies differ with respect to the "MRD-target", time-point of MRD determination, material analyzed, and method applied. How this probably very valuable MRD information in individual patients may be adapted in the daily clinical routine, e.g., to separate patients who need more aggressive therapies from those who may be spared additional-potentially toxic-therapies is still a work-in-progress. With the exception of MRD assessment in acute promyelocytic leukemia (APL), the lack of randomized, prospective trials renders MRD-based decisions and clinical implications in AML a difficult task. As of today, we still do not have proof that early intervention in MRD-positive AML patients would improve outcomes, although this is very likely. In this article, we review the current knowledge on non-APL AML MRD assessment and possible clinical consequences.

摘要

检测白血病原始细胞残留水平(可测量残留病,MRD)的能力已被纳入慢性髓性白血病和急性淋巴细胞白血病患者的日常治疗流程中。在急性髓性白血病(AML)中,大量主要为回顾性的研究表明,与MRD阴性患者相比,在特定时间点MRD检测呈阳性或MRD水平升高的AML缓解期患者复发和死亡风险显著更高。然而,这些研究在“MRD靶点”、MRD测定时间点、分析材料和应用方法方面存在差异。如何在日常临床实践中应用这一可能对个体患者非常有价值的MRD信息,例如,区分哪些患者需要更积极的治疗,哪些患者可以避免额外的潜在毒性治疗,仍在进行中。除了急性早幼粒细胞白血病(APL)的MRD评估外,缺乏随机前瞻性试验使得基于MRD的决策和AML的临床意义成为一项艰巨任务。截至目前,我们仍没有证据表明对MRD阳性的AML患者进行早期干预会改善预后,尽管这种可能性很大。在本文中,我们综述了关于非APL AML MRD评估的现有知识以及可能的临床后果。

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