Molecular remission is an independent predictor of clinical outcome in patients with mantle cell lymphoma after combined immunochemotherapy: a European MCL intergroup study
Molecular remission is an independent predictor of clinical outcome in patients with mantle cell lymphoma after combined immunochemotherapy: a European MCL intergroup study
复制标题
DOI：
10.1182/blood-2009-06-230250
复制
发表时间：
2010-04-22
期刊：
影响因子：
20.3
通讯作者：
Dreyling, Martin
中科院分区：
文献类型：
--
作者：
Pott, Christiane;Hoster, Eva;Dreyling, Martin
在欧洲套细胞淋巴瘤网络（MCL Younger和MCL Elderly试验）的2项随机试验中，分析了259例接受治疗的套细胞淋巴瘤（MCL）患者的微小残留病（MRD）预后影响。在基于利妥昔单抗的诱导治疗后，190例可评价患者中有106例（56%）根据血液和/或骨髓（BM）分析实现了分子缓解（MR）。MR导致缓解持续时间显著改善（RD; 87% vs 61%患者在2年时缓解，P = 0.004），并成为RD的独立预后因素（风险比= 0.4，95%置信区间，0.1-0.9，P = 0.028）。MR对RD延长具有高度预测性，与临床缓解无关（完全缓解[CR]、未确认的完全缓解[CRu]、部分缓解[PR]; 2年时的RD：BM MRD阴性CR/CRu为94%，BM MRD阴性PR为100%，而BM MRD阳性CR/CRu为71%，BM MRD阳性PR为51%，P = 0.002）。诱导后持续MR可预测自体干细胞移植后年轻MCL患者（ASCT; 2年RD：100% vs 65%，P = 0.001）和老年MCL患者（2年RD：76% vs 36%，P = 0.015）维持治疗期间的结局。ASCT使MR患者的比例从高剂量治疗前的55%增加到72%。序贯MRD监测是MCL治疗结果的有力预测因素。这些试验在www.clinicaltrials.gov上注册为#NCT 00209222和#NCT 00209209。（血。2010; 115（16）：3215-3223）
The prognostic impact of minimal residual disease (MRD) was analyzed in 259 patients with mantle cell lymphoma (MCL) treated within 2 randomized trials of the European MCL Network (MCL Younger and MCL Elderly trial). After rituximab-based induction treatment, 106 of 190 evaluable patients (56%) achieved a molecular remission (MR) based on blood and/or bone marrow (BM) analysis. MR resulted in a significantly improved response duration (RD; 87% vs 61% patients in remission at 2 years, P = .004) and emerged to be an independent prognostic factor for RD (hazard ratio = 0.4, 95% confidence interval, 0.1-0.9, P = .028). MR was highly predictive for prolonged RD independent of clinical response (complete response [CR], complete response unconfirmed [CRu], partial response [PR]; RD at 2 years: 94% in BM MRD-negative CR/CRu and 100% in BM MRD-negative PR, compared with 71% in BM MRD-positive CR/CRu and 51% in BM MRD-positive PR, P = .002). Sustained MR during the postinduction period was predictive for outcome in MCL Younger after autologous stem cell transplantation (ASCT; RD at 2 years 100% vs 65%, P = .001) and during maintenance in MCL Elderly (RD at 2 years: 76% vs 36%, P = .015). ASCT increased the proportion of patients in MR from 55% before high-dose therapy to 72% thereafter. Sequential MRD monitoring is a powerful predictor for treatment outcome in MCL. These trials are registered at www.clinicaltrials.gov as #NCT00209222 and #NCT00209209. (Blood. 2010; 115(16): 3215-3223)