Minimal Residual Disease at First Achievement of Complete Remission Predicts Outcome in Adult Patients with Philadelphia Chromosome-Negative Acute Lymphoblastic Leukemia.
Minimal Residual Disease at First Achievement of Complete Remission Predicts Outcome in Adult Patients with Philadelphia Chromosome-Negative Acute Lymphoblastic Leukemia.
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首次完全缓解时的微小残留病可预测费城染色体阴性急性淋巴细胞白血病成年患者的结果
DOI：
10.1371/journal.pone.0163599
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发表时间：
2016
期刊：
影响因子：
3.7
通讯作者：
Huang H
中科院分区：
文献类型：
--
作者：
Zhang M;Fu H;Lai X;Tan Y;Zheng W;Shi J;Zhao Y;Lin M;He J;Cai Z;Luo Y;Huang H
我们评估了费城染色体阴性急性淋巴细胞白血病(ALL)成人患者首次完全缓解(CR1)时微小残留病(MRD)对预后的影响。本研究回顾了2007-2012年间在本中心接受治疗的97例患者。患者根据缓解后接受的治疗(单独化疗或异基因造血干细胞移植(allo-HSCT))分为两组。用四色流式细胞仪检测MRD。通过受试者操作特征分析，我们选择0.02%和0.2%作为CR1的MRD分界点进行风险分层。全组3年总生存率(OS)为46.2%，无白血病生存率(LFS)为40.5%。CR1的MRD与双侧存活率呈显著负相关。化疗组CR1中低、中、高MRD的3年OS率分别为70.0%、25.2%、0%(P=0.003)。移植组CR1中低、中、高水平MRD的3年OS率分别为81.8%、64.3%、27.3%(P=0.005)。多因素分析证实CR1的MRD水平较高是OS和LFS的显著不利因素。与单纯化疗相比，异基因造血干细胞移植显著提高CR1中、高MRD水平(P=0.005)和高MRD(P=0.022)患者的LFS率，但对CR1低MRD水平患者无明显影响(P=0.851)。这些结果表明，CR1的MRD可以很好地预测成人ALL的预后。CR1中高水平MRD的患者将从allo-HSCT中受益。
We evaluated the prognostic effect of minimal residual disease at first achievement of complete remission (MRD at CR1) in adult patients with Philadelphia chromosome-negative acute lymphoblastic leukemia (ALL). A total of 97 patients received treatment in our center between 2007 and 2012 were retrospectively reviewed in this study. Patients were divided into two arms according to the post-remission therapy (chemotherapy alone or allogeneic hematopoietic stem cell transplantation (allo-HSCT)) they received. MRD was detected by four-color flow cytometry. We chose 0.02% and 0.2% as the cut-off points of MRD at CR1 for risk stratification using receiver operating characteristic analysis. The 3-year overall survival (OS) and leukemia free survival (LFS) rates for the whole cohort were 46.2% and 40.5%. MRD at CR1 had a significantly negative correlation with survival in both arms. Three-year OS rates in the chemotherapy arm were 70.0%, 25.2%, 0% (P = 0.003) for low, intermediate, and high levels of MRD at CR1, respectively. Three-year OS rates in the transplant arm were 81.8%, 64.3%, 27.3% (P = 0.005) for low, intermediate, and high levels of MRD at CR1, respectively. Multivariate analysis confirmed that higher level of MRD at CR1 was a significant adverse factor for OS and LFS. Compared with chemotherapy alone, allo-HSCT significantly improved LFS rates in patients with intermediate (P = 0.005) and high (P = 0.022) levels of MRD at CR1, but not patients with low level of MRD at CR1 (P = 0.851). These results suggested that MRD at CR1 could strongly predict the outcome of adult ALL. Patients with intermediate and high levels of MRD at CR1 would benefit from allo-HSCT.
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影响因子：
20.3
作者：
Brüggemann, M;Raff, T;Kneba, M
通讯作者：
Kneba, M
影响因子：
45.3
作者：
Ribera, Josep-Maria;Oriol, Albert;Feliu, Evarist
通讯作者：
Feliu, Evarist
影响因子：
3.6
作者：
Goekbuget, Nicola;Hoelzer, Dieter
通讯作者：
Hoelzer, Dieter
影响因子：
20.3
作者：
Dhedin, Nathalie;Huynh, Anne;Ifrah, Norbert
通讯作者：
Ifrah, Norbert
影响因子：
4.8
作者：
Scrucca, L.;Santucci, A.;Aversa, F.
通讯作者：
Aversa, F.