Ormazabal Vélez Irati, Galbete Jiménez Arkaitz, Sánchez-Escamilla Miriam, Marcos-Jiménez Ana, Fernández-Ruiz Elena, Salmanton-García Jon, Bermúdez Rodríguez Arancha, Figuera Álvarez Ángela
Hematology Department, Hospital Universitario de La Princesa, Madrid, Spain; Facultad de Medicina, Universidad Autónoma de Madrid, Madrid, Spain; Hematology Department, Hospital Universitario de Navarra, Iruña-Pamplona, Spain.
Statitstics, Computing and Mathematics Department, Universidad Pública de Navarra (UPNA), Iruña-Pamplona, Spain.
Med Clin (Barc). 2025 Mar 14;164(5):217-225. doi: 10.1016/j.medcli.2024.09.023. Epub 2024 Nov 26.
In this retrospective study, with prolonged follow-up, we analyze the outcomes of allogeneic hematopoietic stem cell transplantation (allo-HSCT) in adult acute lymphoblastic leukemia (ALL) and the impact of pre-transplantation measurable residual disease (pre-HSCT MRD).
Detection of MRD was performed by multiparametric flow cytometry (MFC) for Philadelphia chromosome-negative ALL (Ph-neg ALL) and by classic genetic tests for Ph-pos ALL.
Among 46 patients in first complete remission (CR1) who had available MRD data, 1- and 3-year cumulative incidences of relapse (CIR) for patients with positive and negative MRD were 47.1% and 52.9% vs. 3.4% and 6.9%, respectively (p<0.001). Disease free survival (DFS) at 1 and 3 years was 82.8% (95% CI 70.1-97.7) and 79.3% (95% CI 65.9-95.5) in the negative MRD group and 35.3% (95% CI 18.5-67.2) and 29.4% (95% CI 14.1-61.4) in the positive MRD group (p<0.001). With a median follow up of 29 months in the entire cohort and 177.6 months (14.8 years) in survivors, 1- and 3-year overall survival (OS) for the pre-HSCT negative MRD group was 82.8% (95% CI 70.1-97.7) and 79.2% (95% CI 65.6-95.5), respectively, compared to 64.7% (95% CI 45.5-91.9) and 41.2% (95% CI 23.3-72.7) in the positive MRD group (p=0.001). In a multivariate model, positive pre-HSCT MRD is associated with increased CIR and poorer DFS and OS.
These results support that pre-HSCT MRD should be eradicated to improve survival of adult ALL patients who undergo allo-HSCT.
在这项回顾性研究中，随着随访时间的延长，我们分析了成人急性淋巴细胞白血病（ALL）患者异基因造血干细胞移植（allo-HSCT）的结局以及移植前可测量残留病（移植前MRD）的影响。
通过多参数流式细胞术（MFC）检测费城染色体阴性ALL（Ph-neg ALL）的MRD，通过经典基因检测检测Ph阳性ALL的MRD。
在46例首次完全缓解（CR1）且有可用MRD数据的患者中，MRD阳性和阴性患者的1年和3年累积复发率（CIR）分别为47.1%和52.9%，以及3.4%和6.9%（p<0.001）。MRD阴性组1年和3年无病生存率（DFS）分别为82.8%（95%CI 70.1-97.7）和79.3%（95%CI 65.9-95.5），MRD阳性组分别为35.3%（95%CI 18.5-67.2）和29.4%（95%CI 14.1-61.4）（p<0.001）。在整个队列中，中位随访时间为29个月，幸存者为177.6个月（14.8年），移植前MRD阴性组的1年和3年总生存率（OS）分别为82.8%（95%CI 70.1-97.7）和79.2%（95%CI 65.6-95.5），而MRD阳性组分别为64.7%（95%CI 45.5-91.9）和41.2%（95%CI 23.3-72.7）（p=0.001）。在多变量模型中，移植前MRD阳性与CIR增加、DFS和OS较差相关。
这些结果支持应消除移植前MRD，以提高接受allo-HSCT的成人ALL患者的生存率。
