Department of Pediatrics, Peking University People's Hospital, Peking University, Beijing, China.
Peking University People's Hospital, Peking University Institute of Hematology, National Clinical Research Center for Hematologic Disease, Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, Beijing, China.
Int J Lab Hematol. 2021 Aug;43(4):752-759. doi: 10.1111/ijlh.13570. Epub 2021 May 14.
Residual disease (RD) detected using multiparametric flow cytometry (MFC) is an independent predictive variable of relapse in acute myeloid leukaemia (AML). However, RD thresholds and optimal assessment time points remain to be validated.
We investigated the significance of RD after induction therapy in paediatric AML with normal karyotype between June 2008 and June 2018. Bone marrow samples from 73 patients were collected at the end of the first (BMA-1) and second (BMA-2) induction courses to monitor RD using MFC.
Presence of RD after BMA-1 and/or BMA-2 correlated with poor relapse-free (RFS) and overall survival at 0.1% RD cutoff level. Receiver operating characteristic curve showed that RD cutoff levels of 1.3% and 0.5% after BMA-1 and BMA-2, respectively, predicted events with the highest sensitivity and specificity. In multivariable analysis, RD after BMA-2 was the strongest independent risk predictor for poor RFS (hazard ratio 2.934; 95% confidence interval: 1.106-7.782; P = .031).
Our study therefore suggests that an RD level ≥0.5% after BMA-2 has a significant predictive impact on the prognosis of AML patients having normal karyotype and thus guide the stratification of treatment strategies.
多参数流式细胞术（MFC）检测到的残留疾病（RD）是急性髓系白血病（AML）复发的独立预测变量。然而，RD 阈值和最佳评估时间点仍有待验证。
我们研究了 2008 年 6 月至 2018 年 6 月期间正常核型儿童 AML 诱导治疗后 RD 的意义。收集了 73 例患者在第一（BMA-1）和第二（BMA-2）诱导疗程结束时的骨髓样本，使用 MFC 监测 RD。
BMA-1 和/或 BMA-2 后 RD 的存在与无复发生存（RFS）和总生存较差相关，在 0.1% RD 截止值水平。受试者工作特征曲线表明，BMA-1 和 BMA-2 后 RD 的截止值分别为 1.3%和 0.5%，可预测具有最高敏感性和特异性的事件。多变量分析显示，BMA-2 后 RD 是 RFS 不良的最强独立风险预测因子（危险比 2.934；95%置信区间：1.106-7.782；P = 0.031）。
因此，我们的研究表明，BMA-2 后 RD 水平≥0.5%对具有正常核型的 AML 患者的预后具有显著的预测影响，从而指导治疗策略的分层。
