Wang Lu-Lu, Zhao Peng, Liu Jing, An Zhuo-Yu, Fu Hai-Xia, Wang Chen-Cong, Lv Meng, Yan Chen-Hua, Han Ting-Ting, Chen Yu-Hong, Kong Jun, Zhang Yuan-Yuan, Chen Yao, Wang Zhi-Dong, Han Wei, He Yun, Mo Xiao-Dong, Wang Feng-Rong, Wang Jing-Zhi, Chang Ying-Jun, Zhao Xiang-Yu, Wang Yu, Xu Lan-Ping, Huang Xiao-Jun, Zhang Xiao-Hui
Peking University People's Hospital, Peking University Institute of Hematology, Beijing, China.
National Clinical Research Center for Hematologic Disease, Beijing, China.
Cancer. 2025 Aug 15;131(16):e70044. doi: 10.1002/cncr.70044.
BACKGROUND: This study examined the impact of measurable residual disease (MRD) dynamics in adults with lysine methyltransferase 2a rearrangement (KMT2Ar) in acute myeloid leukemia (AML) during the peritransplant period (before and early after allogeneic hematopoietic stem cell transplantation [HSCT]). METHODS: This study involved 144 adult patients with AML with KMT2Ar who underwent HSCT between 2015 and 2024. Patients were enrolled if they survived without relapse for at least 3 months post-HSCT. MRD was measured via real-time quantitative polymerase chain reaction. RESULTS: The cohort was categorized into four groups on the basis of MRD status before and after HSCT, respectively: MRD negative/MRD negative (n = 81), MRD negative/MRD positive (n = 2), MRD positive/MRD negative (n = 43), and MRD positive/MRD positive (n = 18). Significant differences were found in 3-year overall survival (OS), leukemia-free survival (LFS), and cumulative incidence of relapse (CIR) (all p < .001), with the MRD-negative/MRD-negative group having the best outcomes (88% OS, 85% LFS, and 10% CIR), whereas the MRD-negative/MRD-positive group (0% OS, 0% LFS, and 100% CIR) and MRD-positive/MRD-positive group (29% OS, 31% LFS, and 69% CIR) had the worst outcomes. The MRD-positive/MRD-negative group had an intermediate prognosis (63% OS, 58% LFS, and 32% CIR). Peri-HSCT MRD dynamics served as an independent factor, which distinguished patient groups with differential risk probabilities of mortality and relapse. C-statistic values were greater when peri-HSCT MRD dynamic testing was used than when isolated pre- or post-HSCT MRD was used to predict CIR (0.68 vs. 0.58 vs. 0.56), LFS (0.74 vs. 0.69 vs. 0.64), and OS (0.73 vs. 0.68 vs. 0.66). CONCLUSIONS: Compared with single-time point MRD assessments, peritransplant MRD dynamics confer superior prognostic accuracy.
背景：本研究探讨了急性髓系白血病（AML）伴赖氨酸甲基转移酶2a重排（KMT2Ar）的成人患者在移植期（异基因造血干细胞移植[HSCT]前及移植后早期）可测量残留病（MRD）动态变化的影响。 方法：本研究纳入了2015年至2024年间接受HSCT的144例AML伴KMT2Ar的成年患者。若患者在HSCT后至少存活3个月且无复发，则纳入研究。通过实时定量聚合酶链反应检测MRD。 结果：根据HSCT前后的MRD状态，该队列分为四组：MRD阴性/MRD阴性（n = 81）、MRD阴性/MRD阳性（n = 2）、MRD阳性/MRD阴性（n = 43）和MRD阳性/MRD阳性（n = 18）。在3年总生存期（OS）、无白血病生存期（LFS）和累积复发率（CIR）方面发现了显著差异（均p <.001），MRD阴性/MRD阴性组预后最佳（OS为88%，LFS为85%，CIR为10%），而MRD阴性/MRD阳性组（OS为0%，LFS为0%，CIR为100%）和MRD阳性/MRD阳性组（OS为29%，LFS为31%，CIR为69%）预后最差。MRD阳性/MRD阴性组预后中等（OS为63%，LFS为58%，CIR为32%）。HSCT围手术期MRD动态变化是一个独立因素，可区分具有不同死亡和复发风险概率的患者组。与单独使用HSCT前或HSCT后的MRD预测CIR（0.68对0.58对0.56）、LFS（0.74对0.69对0.64）和OS（0.73对0.68对0.66）相比，使用HSCT围手术期MRD动态检测时C统计值更高。 结论：与单次MRD评估相比，移植期MRD动态变化具有更高 的预后准确性。
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