不良的移植前微小残留病灶清除作为伴原始细胞增多的骨髓增生异常综合征患者生存的独立预后危险因素：一项多中心回顾性队列研究。

Poor pretransplantation minimal residual disease clearance as an independent prognostic risk factor for survival in myelodysplastic syndrome with excess blasts: A multicenter, retrospective cohort study.

机构信息

Medical Center of Hematology, Xinqiao Hospital, State Key Laboratory of Trauma, Burn and Combined Injury, Army Medical University, Shapingba District, Chongqing, China.

Department of Health Statistics, College of Preventive Medicine, Army Medical University, Shapingba District, Chongqing, China.

出版信息

Cancer. 2023 Jul 1;129(13):2013-2022. doi: 10.1002/cncr.34762. Epub 2023 Mar 23.

DOI:10.1002/cncr.34762

PMID:36951498

Abstract

BACKGROUND

Minimal residual disease (MRD) is an important prognostic factor for survival in adults with acute leukemia. The role of pretransplantation MRD status in myelodysplastic syndrome with excess blasts (MDS-EB) is unknown. This study retrospectively analyzed the relationship between pretransplantation MRD status and long-term survival.

MATERIALS AND METHODS

Patients with MDS-EB who underwent allogeneic hematopoietic stem cell transplantation (allo-HSCT) from March 5, 2005, to November 8, 2020, were included. The relationship between pretransplantation MRD status and long-term survival was analyzed using univariate and multivariate logistic regression models.

RESULTS

Of 220 patients with MDS-EB who underwent allo-HSCT, 198 were eligible for inclusion in this multicenter, retrospective cohort study. Complete remission was attained in 121 (61.1%) patients, and 103 patients underwent detection of MRD pretransplantation, with 67 patients being MRD-positive and 36 patients being MRD-negative. The median follow-up time was 16 months, the median age was 41 years (6-65 years), and 58% of the patients were men. The 3-year disease-free survival (DFS) and overall survival (OS) probabilities for all patients were 70.1% and 72.9%, respectively. For patients in complete remission, the 3-year DFS and OS probabilities were 72.2% and 74.8%, respectively. Further analysis found that the 3-year DFS rates of MRD-negative and MRD-positive patients were 85.6% and 66.5% (p = .045), respectively, whereas the 3-year OS rates were 91.3% and 66.4% (p = .035), respectively. Univariate and multivariate analyses showed that poor pretransplantation MRD clearance was an independent prognostic risk factor for DFS and OS.

CONCLUSION

Poor pretransplantation MRD clearance is an independent prognostic risk factor for long-term survival after allo-HSCT for patients with MDS-EB.

PLAIN LANGUAGE SUMMARY

Poor minimal residual disease clearance pretransplanation is an independent prognostic risk factor for long-term survival after allogeneic hematopoietic stem cell transplantation for patients with myelodysplastic syndrome with excess blasts.

摘要

背景

微小残留病（MRD）是成人急性白血病生存的重要预后因素。移植前 MRD 状态在伴多系发育异常的骨髓增生异常综合征伴原始细胞过多（MDS-EB）中的作用尚不清楚。本研究回顾性分析了移植前 MRD 状态与长期生存的关系。

材料和方法

纳入 2005 年 3 月 5 日至 2020 年 11 月 8 日接受异基因造血干细胞移植（allo-HSCT）的 MDS-EB 患者。采用单因素和多因素 logistic 回归模型分析移植前 MRD 状态与长期生存的关系。

结果

在 220 例接受 allo-HSCT 的 MDS-EB 患者中，198 例符合本多中心回顾性队列研究的纳入标准。121 例（61.1%）患者达到完全缓解，103 例患者在移植前检测到 MRD，其中 67 例为 MRD 阳性，36 例为 MRD 阴性。中位随访时间为 16 个月，中位年龄为 41 岁（6-65 岁），58%的患者为男性。所有患者的 3 年无病生存（DFS）和总生存（OS）概率分别为 70.1%和 72.9%。对于完全缓解的患者，3 年 DFS 和 OS 概率分别为 72.2%和 74.8%。进一步分析发现，MRD 阴性和 MRD 阳性患者的 3 年 DFS 率分别为 85.6%和 66.5%（p=0.045），3 年 OS 率分别为 91.3%和 66.4%（p=0.035）。单因素和多因素分析表明，移植前 MRD 清除不良是 DFS 和 OS 的独立预后危险因素。