Bernasconi Paolo, Borsani Oscar
Department of Molecular Medicine, University of Pavia, 27100 Pavia, Italy.
Hematology Department, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy.
Cancers (Basel). 2021 Jun 25;13(13):3170. doi: 10.3390/cancers13133170.
In non-promyelocytic (non-M3) AML measurable residual disease (MRD) detected by multi-parameter flow cytometry and molecular technologies, which are guided by Consensus-based guidelines and discover very low leukemic cell numbers far below the 5% threshold of morphological assessment, has emerged as the most relevant predictor of clinical outcome. Currently, it is well-established that MRD positivity after standard induction and consolidation chemotherapy, as well as during the period preceding an allogeneic hematopoietic stem cell transplant (allo-HSCT), portends to a significantly inferior relapse-free survival (RFS) and overall survival (OS). In addition, it has become absolutely clear that conversion from an MRD-positive to an MRD-negative state provides a favorable clinical outcome similar to that associated with early MRD negativity. Thus, the complete eradication of MRD, i.e., the clearance of the few leukemic stem cells-which, due to their chemo-radiotherapy resistance, might eventually be responsible of disease recurrence-has become an un-met clinical need in AML. Nowadays, this goal might potentially be achieved thanks to the development of novel innovative treatment strategies, including those targeting driver mutations, apoptosis, methylation patterns and leukemic proteins. The aim of this review is to analyze these strategies and to suggest any potential combination able to induce MRD negativity in the pre- and post-HSCT period.
在非早幼粒细胞性(非M3)急性髓系白血病(AML)中,通过多参数流式细胞术和分子技术检测到的微小残留病(MRD)已成为临床结局最相关的预测指标。这些技术以基于共识的指南为指导,能够发现远低于形态学评估5%阈值的极低白血病细胞数量。目前,已经明确的是,标准诱导和巩固化疗后以及异基因造血干细胞移植(allo-HSCT)前的MRD阳性预示着无复发生存期(RFS)和总生存期(OS)显著较差。此外,从MRD阳性状态转变为MRD阴性状态可带来与早期MRD阴性相似的良好临床结局,这一点也已非常明确。因此,彻底清除MRD,即清除少数白血病干细胞(由于其对放化疗具有抗性,最终可能导致疾病复发),已成为AML中尚未满足的临床需求。如今,由于新型创新治疗策略的发展,包括针对驱动突变、凋亡、甲基化模式和白血病蛋白的策略,这一目标有可能实现。本综述的目的是分析这些策略,并提出任何能够在HSCT前后诱导MRD阴性的潜在联合方案。