Row Céline, Lechevalier Nicolas, Vial Jean Philippe, Mimoun Aguirre, Bastie Jean Noel, Lafon Ingrid, Pigneux Arnaud, Leguay Thibaut, Callanan Mary, Maynadie Marc, Béné Marie C, Dumas Pierre Yves, Guy Julien
Service d'Hématologie Biologique CHU de Dijon Dijon France.
University of Burgundy-ISITE-BFC-Institut National de la Santé et de la Recherche Médicale (Inserm) UMR1231 Faculty of Medicine Dijon France.
EJHaem. 2024 Jan 10;5(1):84-92. doi: 10.1002/jha2.822. eCollection 2024 Feb.
Risk stratification and treatment response evaluation are key features in acute myeloid leukemia (AML) management. Immunophenotypic and molecular approaches all rely on the detection of persisting leukemic cells by measurable residual disease techniques. A new approach is proposed here by assessing medullary myeloid maturation by flow cytometry through a myeloid progenitor ratio (MPR). The normal MPR range was defined using reference normal bone marrows ( = 48). MPR was considered balanced if between 1 and 4 and unbalanced if < 1 or > 4. MPR was retrospectively assessed at baseline and post-induction for 206 newly diagnosed AML patients eligible for intensive treatment from two different French centers. All AML baseline MPR were unbalanced and thus significantly different from normal MPR ( < 0.0001). Patients with an unbalanced MPR after induction had worse 3-year overall survival (OS) (44.4% vs. 80.2%, HR, 2.96; 95% CI, 1.81-4.84, < 0.0001) and 3-year relapse free survival (RFS) (38.7% vs. 64.4%, HR, 2.11; 95% CI, 1.39-3.18, < 0.001). In multivariate analysis, postinduction unbalanced MPR was significantly associated with shorter OS and RFS regardless of the European LeukemiaNet 2010 risk stratification or NPM1/FLT3-ITD status. A balanced postinduction MPR conversely conferred favorable outcomes and reflects medullary myeloid recovery.
风险分层和治疗反应评估是急性髓系白血病（AML）管理的关键特征。免疫表型和分子方法均依赖于通过可测量残留病技术检测持续存在的白血病细胞。本文提出了一种新方法，即通过流式细胞术评估髓系祖细胞比率（MPR）来评估骨髓髓系成熟度。使用参考正常骨髓（n = 48）定义正常MPR范围。MPR在1至4之间被认为是平衡的，<1或>4则为不平衡。对来自法国两个不同中心的206例符合强化治疗条件的新诊断AML患者在基线和诱导后进行了MPR的回顾性评估。所有AML患者的基线MPR均不平衡，因此与正常MPR有显著差异（P<0.0001）。诱导后MPR不平衡的患者3年总生存期（OS）较差（44.4%对80.2%，HR，2.96；95%CI，1.81 - 4.84，P<0.0001），3年无复发生存期（RFS）也较差（38.7%对64.4%，HR，2.11；95%CI，1.39 - 3.18，P<0.001）。在多变量分析中，无论欧洲白血病网络2010风险分层或NPM1/FLT3 - ITD状态如何，诱导后MPR不平衡均与较短的OS和RFS显著相关。相反，诱导后MPR平衡则带来良好的预后，并反映骨髓髓系恢复。
