Impact of post-transplant minimal residual disease on the clinical outcome of pediatric acute leukemia
Impact of post-transplant minimal residual disease on the clinical outcome of pediatric acute leukemia
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移植后微小残留病对小儿急性白血病临床结局的影响
DOI：
10.1111/petr.12926
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发表时间：
2017
影响因子：
1.3
通讯作者：
Adachi Souichi
中科院分区：
文献类型：
--
作者：
Umeda Katsutsugu;Iwai Atsushi;Kawaguchi Koji;Mikami Masamitsu;Nodomi Seishiro;Saida Satoshi;Hiramatsu Hidefumi;Heike Toshio;Ohmori Katsuyuki;Adachi Souichi
这项回顾性研究探讨了36例ALL患者和29例AML患者首次异基因HSCT后FCM-MRD的临床意义。血液学(FCM-MRD≥5.0%)和分子复发(FCM-MRD<；5.0%)分别在10例和2例ALL患者和7例和8例急性髓系白血病患者中首次检测到。在10名分子复发的患者中，有8名最终进展为血液学复发，尽管大多数患者接受了免疫干预，即积极停止免疫抑制治疗或供者淋巴细胞输注。在这12名患者中，在移植后化疗后获得MRDenerCR的7名患者中，有4名在第二次HSCT后仍然存活和无病；然而，所有5名在非CR中接受第二次HSCT的患者都死于疾病或治疗相关的并发症。由于目前研究中使用的FCM-MRD监测系统可能不够敏感，无法检测到MRD，这可以通过免疫干预来阐明，因此必须使用更灵敏的诊断工具来监测移植后的MRD。需要更多的研究来解决第二次移植前MRD对第二次HSCT临床结果的影响。
This retrospective study examined the clinical significance of FCM‐MRD in 36 patients with ALL and 29 patients with AML after their first allogeneic HSCT. Hematological (FCM‐MRD ≥5.0%) and molecular relapse (FCM‐MRD <5.0%) were first detected in 10 and two patients with ALL and in seven and eight patients with AML, respectively. Eight of 10 patients with molecular relapse eventually progressed to hematological relapse, although most were treated with immunological intervention by aggressive discontinuation of immunosuppressive therapy or donor lymphocyte infusion. Among these 12 patients, four of seven patients that obtained MRDnegCR following post‐transplant chemotherapy remain alive and disease‐free after their second HSCT; however, all five patients who underwent a second HSCT in non‐CR died of disease or treatment‐related complications. As the FCM‐MRD monitoring system used in the current study was probably not sensitive enough to detect MRD, which could be elucidated by immunological intervention, more sensitive diagnostic tools are mandatory for post‐transplant MRD monitoring. Additional studies are required to address the impact of presecond transplant MRD on the clinical outcome of second HSCT.