Role of minimal residual disease monitoring in acute promyelocytic leukemia treated with arsenic trioxide in frontline therapy
Role of minimal residual disease monitoring in acute promyelocytic leukemia treated with arsenic trioxide in frontline therapy
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DOI：
10.1182/blood-2011-11-393264
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发表时间：
2012-04-12
期刊：
影响因子：
20.3
通讯作者：
Mathews, Vikram
中科院分区：
文献类型：
--
作者：
Chendamarai, Ezhilarasi;Balasubramanian, Poonkuzhali;Mathews, Vikram
急性早幼粒细胞白血病 (APL) 微小残留病 (MRD) 监测数据仅在常规全反式维A酸加化疗方案的情况下可用。人们认识到，在 APL 治疗中使用三氧化二砷 (ATO) 时，白血病清除的动力学是不同的。我们对接受单药 ATO 方案治疗的 APL 患者进行了一项基于前瞻性外周血 RT-PCR 的 MRD 监测研究。共有 151 名患者参加了这项研究。多变量分析表明，诱导治疗结束时 RT-PCR 读数呈阳性与复发风险增加显着相关（相对风险 = 4.9；P = .034）。诱导结束时 RT-PCR 阴性的高风险患者均未出现复发。大多数复发（91%）发生在治疗完成后 3 年内。实现分子缓解后，目前的 MRD 监测策略能够预测 60% 的病例复发，总体敏感性和特异性分别为 60% 和 93.2%。高危组患者和诱导结束时仍保持 RT-PCR 阳性的患者可能会受益于治疗完成后 3 年期间通过 RT-PCR 进行的连续 MRD 监测。 （血。2012；119（15）：3413-3419）
Data on minimal residual disease (MRD) monitoring in acute promyelocytic leukemia (APL) are available only in the context of conventional all-trans retinoic acid plus chemotherapy regimens. It is recognized that the kinetics of leukemia clearance is different with the use of arsenic trioxide (ATO) in the treatment of APL. We undertook a prospective peripheral blood RT-PCR-based MRD monitoring study on patients with APL treated with a single agent ATO regimen. A total of 151 patients were enrolled in this study. A positive RT-PCR reading at the end of induction therapy was significantly associated on a multivariate analysis with an increased risk of relapse (relative risk = 4.9; P = .034). None of the good risk patients who were RT-PCR negative at the end of induction relapsed. The majority of the relapses (91%) happened within 3 years of completion of treatment. After achievement of molecular remission, the current MRD monitoring strategy was able to predict relapse in 60% of cases with an overall sensitivity and specificity of 60% and 93.2%, respectively. High-risk group patients and those that remain RT-PCR positive at the end of induction are likely to benefit from serial MRD monitoring by RT-PCR for a period of 3 years from completion of therapy. (Blood. 2012; 119(15):3413-3419)