Peking University People's Hospital and Peking University Institute of Hematology, National Clinical Research Center for Hematologic Disease, Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, Beijing, 100044, China.
Research Unit of Key Technique for Diagnosis and Treatments of Hematologic Malignancies, Chinese Academy of Medical Sciences, Beijing, 100005, China.
Curr Med Sci. 2021 Jun;41(3):443-453. doi: 10.1007/s11596-021-2390-6. Epub 2021 Jun 28.
We performed a retrospective analysis to investigate dynamic peri-hematopoietic stem cell transplantation (HSCT) minimal/measurable residual disease (MRD) on outcomes in patients with T-cell acute lymphoblastic leukemia (T-ALL). A total of 271 patients were enrolled and classified into three groups: unchanged negative MRD pre- and post-HSCT group (group A), post-MRD non-increase group (group B), and post-MRD increase group (group C). The patients in group B and group C experienced a higher cumulative incidence of relapse (CIR) (42% vs. 71% vs. 16%, P<0.001) and lower leukemia-free survival (LFS) (46% vs. 21% vs. 70%, P<0.001) and overall survival (OS) (50% vs. 28% vs. 72%, P<0.001) than in group A, but there was no significant difference in non-relapse mortality (NRM) among three groups (14% vs. 12% vs. 8%, P=0.752). Multivariate analysis showed that dynamic peri-HSCT MRD was associated with CIR (HR=2.392, 95% CI, 1.816-3.151, P<0.001), LFS (HR=1.964, 95% CI, 1.546-2.496, P<0.001) and OS (HR=1.731, 95% CI, 1.348-2.222, P<0.001). We also established a risk scoring system based on dynamic peri-HSCT MRD combined with remission status pre-HSCT and onset of chronic graft-versus-host disease (GVHD). This risk scoring system could better distinguish CIR (c=0.730) than that for pre-HSCT MRD (c=0.562), post-HSCT MRD (c=0.616) and pre- and post-MRD dynamics (c=0.648). Our results confirm the outcome predictive value of dynamic peri-HSCT MRD either alone or in combination with other variables for patients with T-ALL.
我们进行了一项回顾性分析，旨在研究 T 细胞急性淋巴细胞白血病（T-ALL）患者造血干细胞移植（HSCT）前后微小/可测量残留病（MRD）的动态变化对结局的影响。共纳入 271 例患者，并分为三组：HSCT 前后 MRD 持续阴性组（A 组）、MRD 无增加组（B 组）和 MRD 增加组（C 组）。B 组和 C 组患者累积复发率（CIR）较高（42%比 71%比 16%，P<0.001），无白血病生存率（LFS）（46%比 21%比 70%，P<0.001）和总生存率（OS）（50%比 28%比 72%，P<0.001）均低于 A 组，但三组间非复发死亡率（NRM）无显著差异（14%比 12%比 8%，P=0.752）。多因素分析显示，HSCT 前后动态 MRD 与 CIR（HR=2.392，95%CI，1.816-3.151，P<0.001）、LFS（HR=1.964，95%CI，1.546-2.496，P<0.001）和 OS（HR=1.731，95%CI，1.348-2.222，P<0.001）相关。我们还建立了一个基于 HSCT 前后动态 MRD 结合 HSCT 前缓解状态和慢性移植物抗宿主病（GVHD）发病的风险评分系统。该风险评分系统在区分 CIR 方面优于 HSCT 前 MRD（c=0.562）、HSCT 后 MRD（c=0.616）和 HSCT 前后动态变化（c=0.648）（c=0.730）。我们的结果证实了 HSCT 前后动态 MRD 单独或与其他变量联合对 T-ALL 患者的预后预测价值。
