MRD-directed risk stratification treatment may improve outcomes of t(8;21) AML in the first complete remission: results from the AML05 multicenter trial
MRD-directed risk stratification treatment may improve outcomes of t(8;21) AML in the first complete remission: results from the AML05 multicenter trial
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MRD 导向的风险分层治疗可能会改善 t(8;21) AML 在首次完全缓解时的结局：AML05 多中心试验的结果
DOI：
10.1182/blood-2012-11-468348
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发表时间：
2013-05-16
期刊：
影响因子：
20.3
通讯作者：
Huang, Xiao-Jun
中科院分区：
文献类型：
--
作者：
Zhu, Hong-Hu;Zhang, Xiao-Hui;Huang, Xiao-Jun
我们旨在通过基于RUNX1/Runx1t1转录本水平确定的微小残留病(MRD)的风险定向治疗来改善首次完全缓解(CR1)中t(8；21)急性髓系白血病(AML)的预后。风险导向治疗包括对高危患者推荐异基因造血干细胞移植(allo-HSCT)，对低危患者推荐化疗/自体造血干细胞移植(Auto-HSCT)。在116名符合条件的患者中，第二次巩固后的MRD状态比诱导或第一次巩固后的MRD状态更能区分高危复发患者(P=.001)。对于高危患者，异基因造血干细胞移植可减少复发，提高生存率(累积复发率[CIR]：22.1%vs 78.9%，P<；0.0001；无病生存率[DFS]：61.7%vs 19.6%，P=.001)，而低危患者化疗/自体造血干细胞移植复发率低(5.3%)，无病生存率(DFS)高(94.7%)。多变量分析显示，MRD状态和治疗选择是复发、DFS和OS的独立预后因素。我们得出结论，第二次合并后的MRD状态可能是治疗选择的最佳时机。MRD指导的风险分层治疗可能改善CR1中t(8；21)AML的预后。这项试验登记在http://www.chictr.orgas#chictr-och-12002406。
We aimed to improve the outcome of t(8;21) acute myeloid leukemia (AML) in the first complete remission (CR1) by applying risk-directed therapy based on minimal residual disease (MRD) determined by RUNX1/RUNX1T1 transcript levels. Risk-directed therapy included recommending allogeneic hematopoietic stem cell transplantation (allo-HSCT) for high-risk patients and chemotherapy/autologous-HSCT (auto-HSCT) for low-risk patients. Among 116 eligible patients, MRD status after the second consolidation rather than induction or first consolidation could discriminate high-risk relapse patients (P = .001). Allo-HSCT could reduce relapse and improve survival compared with chemotherapy for high-risk patients (cumulative incidence of relapse [CIR]: 22.1% vs 78.9%, P < .0001; disease-free survival [DFS]: 61.7% vs 19.6%, P = .001), whereas chemotherapy/auto-HSCT achieved a low relapse rate (5.3%) and high DFS (94.7%) for low-risk patients. Multivariate analysis revealed that MRD status and treatment choice were independent prognostic factors for relapse, DFS, and OS. We concluded that MRD status after the second consolidation may be the best timing for treatment choice. MRD-directed risk stratification treatment may improve the outcome of t(8; 21) AML in CR1. This trial was registered at http://www.chictr.orgas #ChiCTR-OCH-12002406.