Liu Jie, Guo Dan, Lian Hanxi, Ding Peiwen, Liu Xin, Zhao Yanqiu, Li Huibo, Fan Shengjin
Division of Hematology, Department of Medicine, The First Affiliated Hospital of Harbin Medical University, 23 Youzheng Street, Nan Gang District, Harbin, 150001, Heilongjiang Province, China.
NHC Key Laboratory of Cell Transplantation, the First Affiliated Hospital, Harbin Medical University, Harbin, 150001, China.
Ann Hematol. 2025 Apr 28. doi: 10.1007/s00277-025-06384-0.
Minimal residual disease (MRD) monitoring has been demonstrated to important in predicting prognosis in acute myeloid leukemia (AML) receiving allogeneic hematopoietic stem cell transplantation (allo-HSCT), but the ideal time point and method remain unclear. Our study compared the prognostic value of multiparameter flow cytometry (MFC)-based and WT1 expression-based MRD a month before allo-HSCT [HSCT(-1 m)] and after allo-HSCT [HSCT(+ 1 m)], as well as next generation sequencing (NGS)-based MRD at HSCT(-1 m), HSCT(+ 1 m), 3 and 6 months after allo-HSCT [HSCT(+ 3 m) and HSCT(+ 6 m)] among 47 AML patients undergoing allo-HSCT. The MRD status by all the methods at HSCT(-1 m) was proved as a superior indicator with prognostic significance for disease progression, compared to that at HSCT(+ 1 m). For the NGS-based MRD, HSCT(+ 6 m) seemed to be the optimal detection time point, as supported by the optimal prognostic discrimination capability and the relatively high sensitivity for disease progression prediction. Moreover, our data showed that each individual method had some limitations in predicting prognosis; however, pre-transplant MRD monitoring by the combination of MFC, WT1 and NGS could greatly increase the sensitivity (100%) of identifying disease progression and greatly improve prognostic stratification. Our study may provide insights into the optimal time point and methodology for MRD monitoring in AML following allo-HSCT.
微小残留病（MRD）监测已被证明在预测接受异基因造血干细胞移植（allo-HSCT）的急性髓系白血病（AML）患者的预后方面具有重要意义，但理想的时间点和方法仍不明确。我们的研究比较了基于多参数流式细胞术（MFC）和基于WT1表达的MRD在allo-HSCT前1个月[HSCT(-1 m)]和allo-HSCT后1个月[HSCT(+1 m)]的预后价值，以及基于二代测序（NGS）的MRD在HSCT(-1 m)、HSCT(+1 m)、allo-HSCT后3个月和6个月[HSCT(+3 m)和HSCT(+6 m)]时的预后价值，研究对象为47例接受allo-HSCT的AML患者。与HSCT(+1 m)时相比，HSCT(-1 m)时所有方法检测的MRD状态被证明是疾病进展的具有预后意义的更好指标。对于基于NGS的MRD，HSCT(+6 m)似乎是最佳检测时间点，这得到了最佳预后判别能力和对疾病进展预测相对较高敏感性的支持。此外，我们的数据表明，每种单独的方法在预测预后方面都有一些局限性；然而，通过MFC、WT1和NGS联合进行移植前MRD监测可以大大提高识别疾病进展的敏感性（100%），并大大改善预后分层。我们的研究可能为allo-HSCT后AML患者MRD监测的最佳时间点和方法提供见解。
