Minimal residual disease analysis in chronic lymphocytic leukemia: a way for achieving more personalized treatments
Minimal residual disease analysis in chronic lymphocytic leukemia: a way for achieving more personalized treatments
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DOI：
10.1038/s41375-018-0109-x
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发表时间：
2018-06-01
期刊：
影响因子：
11.4
通讯作者：
Rawstron, Andy
中科院分区：
文献类型：
--
作者：
Ghia, Paolo;Rawstron, Andy
慢性淋巴细胞白血病（CLL）的治疗方法在最近发生了巨大的变化。同时，最小残留病（MRD）的量化被证明是无进展和总生存期的独立预后因素。欧洲CLL研究计划（ERIC）与美国和澳大利亚的合作伙伴合作开发了统一的测定方法，可以重复地应用于比较不同治疗方法的疗效。在欧洲，MRD分析在达到生存终点之前识别最有效治疗的潜力得到了监管机构的认可，并被批准作为随机研究的中间终点。最近的治疗方法已经发展，特别是bcl2途径抑制剂，因此MRD分析可能为大多数患者和临床试验提供信息，有可能成为临床实践中管理CLL患者的工具。在最近的过去，MRD检测类型的重要性、评估不同治疗类型的最合适时机和间隔已经被了解，因为我们正朝着根除残留疾病的方向发展，超过了万分之一的指导阈值。如今，CLL的MRD评估已迅速成为临床研究和开发中不可或缺的工具，有望改变我们未来管理患者的方式。
Therapeutic approaches for chronic lymphocytic leukemia (CLL) have dramatically changed over the recent past. In parallel, quantification of minimal residual disease (MRD) proved to be an independent prognostic factor for progression-free and overall survival. The European Research Initiative on CLL (ERIC) in collaboration with American and Australasian partners developed harmonised assays that could be applied reproducibly to compare the efficacy of different treatments. The potential for MRD analysis to identify the most effective treatments prior to reaching survival endpoints was recognised by regulatory agencies and approved as an intermediate endpoint for licensure in randomized studies, in Europe. More recently treatment approaches have evolved, in particular with BCL2-pathway inhibitors, so that MRD analysis may be informative for most patients and clinical trials, potentially becoming a tool for managing CLL patients in clinical practice. In the recent past the importance of the type of MRD assay used, the most appropriate timing and compartment to assess for different treatment types have been learnt as we move towards eradicating residual disease beyond the guideline threshold of one cell in ten thousand. Nowadays, MRD assessment in CLL has quickly become an indispensable tool for clinical research and development that promise to change the way we manage our patients in the future.