Caballero-Velázquez Teresa, Pérez-López Olga, Yeguas Bermejo Ana, Rodríguez Arbolí Eduardo, Colado Varela Enrique, Sempere Talens Amparo, Vidriales María Belén, Solé-Rodríguez María, Quirós Caso Covadonga, Pérez López Estefanía, Reinoso Segura Marta, Prats-Martín Concepción, Montesinos Pau, Pérez-Simón Jose A
Department of Haematology, Instituto de Biomedicina de Sevilla (IBIS/CSIC), University Hospital Virgen del Rocío, Universidad de Sevilla, 41013 Seville, Spain.
Department of Haematology, University Hospital Virgen del Macarena, 41009 Seville, Spain.
Cancers (Basel). 2023 Mar 5;15(5):1609. doi: 10.3390/cancers15051609.
Allogeneic hematopoietic stem cell transplantation (HSCT) represents the best therapeutic option for many patients with acute myeloid leukemia (AML). However, relapse remains the main cause of mortality after transplantation. The detection of measurable residual disease (MRD) by multiparameter flow cytometry (MFC) in AML, before and after HSCT, has been described as a powerful predictor of outcome. Nevertheless, multicenter and standardized studies are lacking. A retrospective analysis was performed, including 295 AML patients undergoing HSCT in 4 centers that worked according to recommendations from the Euroflow consortium. Among patients in complete remission (CR), MRD levels prior to transplantation significantly influenced outcomes, with overall (OS) and leukemia free survival (LFS) at 2 years of 76.7% and 67.6% for MRD-negative patients, 68.5% and 49.7% for MRD-low patients (MRD < 0.1), and 50.5% and 36.6% for MRD-high patients (MRD ≥ 0.1) ( < 0.001), respectively. MRD level did influence the outcome, irrespective of the conditioning regimen. In our patient cohort, positive MRD on day +100 after transplantation was associated with an extremely poor prognosis, with a cumulative incidence of relapse of 93.3%. In conclusion, our multicenter study confirms the prognostic value of MRD performed in accordance with standardized recommendations.
异基因造血干细胞移植（HSCT）是许多急性髓系白血病（AML）患者的最佳治疗选择。然而，复发仍然是移植后死亡的主要原因。通过多参数流式细胞术（MFC）检测AML患者HSCT前后的可测量残留病（MRD），已被描述为预后的有力预测指标。然而，缺乏多中心的标准化研究。我们进行了一项回顾性分析，纳入了4个按照欧洲流式细胞术联盟建议开展工作的中心的295例接受HSCT的AML患者。在完全缓解（CR）的患者中，移植前的MRD水平对预后有显著影响，MRD阴性患者的2年总生存期（OS）和无白血病生存期（LFS）分别为76.7%和67.6%，MRD低水平患者（MRD < 0.1）为68.5%和49.7%，MRD高水平患者（MRD≥0.1）为50.5%和36.6%（<0.001）。无论预处理方案如何，MRD水平确实会影响预后。在我们的患者队列中，移植后第100天MRD阳性与极差的预后相关，复发累积发生率为93.3%。总之，我们的多中心研究证实了按照标准化建议进行的MRD的预后价值。
