Department of Leukemia.
Division of Cancer Medicine.
Blood Adv. 2020 Dec 22;4(24):6117-6126. doi: 10.1182/bloodadvances.2020002811.
In relapsed/refractory acute myeloid leukemia (AML), the prognostic impact of complete remission (CR) and measurable residual disease (MRD) negativity is not well established. We retrospectively analyzed 141 patients with relapsed/refractory AML who received first salvage therapy and had MRD assessed by multiparameter flow cytometry at the time of response. Patients who achieved CR with full hematologic recovery as best response vs those with incomplete hematology recovery had lower cumulative incidence of relapse (P = .01) and better relapse-free survival (P = .004) but not overall survival (P = .15); a similar trend was observed in patients who achieved MRD negativity vs those who were MRD positive (P = .01, P = .05, and P = .21, respectively). By multivariate analysis, CR and MRD negativity were each independently associated with lower cumulative incidence of relapse (P = .001 and P = .003, respectively) and better relapse-free survival (P < .001 and P = .02) but not overall survival. Patients who achieved CR with MRD negativity had the lowest rates of relapse and best survival (2-year overall survival rate, 37%), which was driven largely by lower rates of early relapse and an increased ability in this group to undergo hematopoietic stem cell transplantation (HSCT); however, post-HSCT outcomes were similar regardless of response to salvage chemotherapy. Overall, in patients with relapsed/refractory AML, CR with MRD negativity was associated with the best outcomes, supporting it as the optimal response in this setting.
在复发/难治性急性髓系白血病（AML）中，完全缓解（CR）和可测量残留疾病（MRD）阴性的预后影响尚未得到充分确立。我们回顾性分析了 141 例接受首次挽救治疗且在缓解时通过多参数流式细胞术评估 MRD 的复发/难治性 AML 患者。最佳反应为完全血液学恢复的 CR 患者与不完全血液学恢复的患者相比，累积复发率较低（P =.01），无复发生存率更好（P =.004），但总生存率无差异（P =.15）；在达到 MRD 阴性的患者中也观察到类似的趋势（P =.01、P =.05 和 P =.21）。通过多变量分析，CR 和 MRD 阴性均与较低的累积复发率独立相关（P =.001 和 P =.003），无复发生存率更好（P <.001 和 P =.02），但总生存率无差异。达到 CR 且 MRD 阴性的患者复发率最低，生存状况最佳（2 年总生存率为 37%），这主要归因于早期复发率较低，且该组患者接受造血干细胞移植（HSCT）的能力提高；然而，无论挽救化疗的反应如何，HSCT 后的结果相似。总体而言，在复发/难治性 AML 患者中，MRD 阴性的 CR 与最佳结果相关，支持其作为该情况下的最佳反应。
