Zhao Zihan, Lan Jianping
The Second Clinical Medical College, Hangzhou Normal University, Hangzhou, Zhejiang, China.
Cancer Center, Department of Hematology, Affiliated People's Hospital, Zhejiang Provincial People's Hospital, Hangzhou Medical College, 58 Shangtang Road, Zhejiang, Hangzhou, 310014, China.
Ann Hematol. 2024 Dec;103(12):4869-4881. doi: 10.1007/s00277-024-06008-z. Epub 2024 Sep 16.
Measurable residual disease (MRD) in acute myeloid leukemia (AML) refers to the quantity of residual leukemic cells in a patient after treatment.According to the latest agreements, MRD in AML offering essential prognostic insights. However, there is ongoing debate regarding MRD-based monitoring and treatment strategies. There are multiple platforms for detecting MRD, each varying in sensitivity and suitability for different patients. MRD not only predicts treatment outcomes but also serves as an indicator of treatment effectiveness and a prognostic biomarker. In AML, most retrospective studies indicate that patients who are MRD-positive or show increasing MRD levels at specific time points during remission have significantly higher risks of relapse and mortality compared to MRD-negative patients. Although achieving MRD-negative status can improve patient prognosis, the possibility of relapse remains. Despite the correlation between MRD and clinical outcomes, MRD assessment methods are not yet standardized, leading to discrepancies in results across different techniques. To provide reliable MRD results, it is essential to optimize and standardize MRD detection methods. Methods for assessing MRD include multiparameter flow cytometry (MFC) and molecular assays, chosen based on disease characteristics. This review focuses on currently available MRD detection methods and discusses how the prognostic value of MRD test results informs personalized treatment strategies for AML patients.
急性髓系白血病(AML)中的可测量残留病(MRD)是指患者治疗后残留白血病细胞的数量。根据最新共识,AML中的MRD提供了重要的预后信息。然而,关于基于MRD的监测和治疗策略仍存在争议。有多种检测MRD的平台,每种平台在灵敏度和对不同患者的适用性方面各不相同。MRD不仅可预测治疗结果,还可作为治疗效果的指标和预后生物标志物。在AML中,大多数回顾性研究表明,与MRD阴性患者相比,在缓解期特定时间点MRD呈阳性或MRD水平升高的患者复发和死亡风险显著更高。尽管实现MRD阴性状态可改善患者预后,但仍有复发的可能性。尽管MRD与临床结果之间存在相关性,但MRD评估方法尚未标准化,导致不同技术的结果存在差异。为了提供可靠的MRD结果,优化和标准化MRD检测方法至关重要。评估MRD的方法包括多参数流式细胞术(MFC)和分子检测,可根据疾病特征进行选择。本综述重点介绍了目前可用的MRD检测方法,并讨论了MRD检测结果的预后价值如何为AML患者的个性化治疗策略提供依据。