Lazzarotto Davide, Candoni Anna
Division of Hematology and Stem Cell Transplantation, ASUFC, University of Udine, 33100 Udine, Italy.
J Clin Med. 2022 Jun 9;11(12):3306. doi: 10.3390/jcm11123306.
The Minimal Residual Disease(MRD) monitoring in acute myeloid leukemia (AML) is crucial to guide treatment after morphologic complete remission, to define the need for consolidation with allogeneic stem cell transplantation (Allo-SCT), and to detect impending relapse allowing early intervention. However, more than 50% of patients with AML lack a specific or measurable molecular marker to monitor MRD. We reviewed the key studies on WT1 overexpression as a marker of MRD in AML patients undergoing an intensive chemotherapy program, including Allo-SCT. In addition, we provided some practical considerations on how to properly use WT1 expression as an MRD marker, considering its strengths and weaknesses. In order to achieve the best sensitivity and specificity, it is recommended to refer to the standardized method of European LeukemiaNet and its defined threshold (250 WT1 copies/10 Abelson (ABL) on Bone Marrow-BM and 50 WT1 copies/10 ABL on Peripheral Blood-PB), which has been validated in a large and multicenter cohort of patients and normal controls.
急性髓系白血病（AML）中的微小残留病（MRD）监测对于指导形态学完全缓解后的治疗、确定进行异基因干细胞移植（Allo-SCT）巩固治疗的必要性以及检测即将复发以便早期干预至关重要。然而，超过50%的AML患者缺乏用于监测MRD的特异性或可测量分子标志物。我们回顾了关于WT1过表达作为接受强化化疗方案（包括Allo-SCT）的AML患者MRD标志物的关键研究。此外，考虑到WT1表达作为MRD标志物的优缺点，我们提供了一些关于如何正确使用它的实际考量。为了实现最佳的敏感性和特异性，建议参考欧洲白血病网的标准化方法及其定义的阈值（骨髓（BM）中每10个阿贝尔森（ABL）有250个WT1拷贝，外周血（PB）中每10个ABL有50个WT1拷贝），该方法已在大量多中心患者和正常对照队列中得到验证。
