Prognostic significance of flow-cytometry evaluation of minimal residual disease in children with acute myeloid leukaemia treated according to the AIEOP-AML 2002/01 study protocol
Prognostic significance of flow-cytometry evaluation of minimal residual disease in children with acute myeloid leukaemia treated according to the AIEOP-AML 2002/01 study protocol
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DOI：
10.1111/bjh.14523
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发表时间：
2017-04-01
影响因子：
6.5
通讯作者：
Basso, Giuseppe
中科院分区：
文献类型：
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作者：
Buldini, Barbara;Rizzati, Frida;Basso, Giuseppe
对于患有急性髓系白血病（AML）的儿童，初始治疗反应的评估是一个重要的预后因素；比形态学更敏感的方法仍在评估中。我们报告了在一个中心实验室通过多色流式细胞术对参加意大利肿瘤协会儿科-AML 2002/01 试验的 142 名新诊断 AML 儿童进行的微小残留病 (MRD) 测量。在第一个诱导疗程结束时，69 名患者的 MRD < 0.1%，16 名患者的 MRD 为 0.11%，51 名患者的 MRD > 1%。 125 例形态学完全缓解且 MRD < 0.1%、0.1-1% 和≥ 1% 的儿童的 8 年无病生存率 (DFS) 分别为 73.1 +/- 5.6%、37.8 +/- 12.1% 和 34.1 +/- 8.8%（P < 0.01）。 92/142 名患者在第二次诱导疗程后也可获得 MRD。 36 名患者在第一次诱导疗程结束时 MRD >= 0.1%； 13 名患者在第二次治疗后达到 MRD < 0.1%，其 DFS 为 45.4 +/- 16.7%，而持续 MRD >= 0.1% 的患者的 DFS 为 22.8 +/- 8.9% (P = 0.037)。多变量分析表明，第一次诱导过程后 MRD >= 0.1% 与单体核型一起是 DFS 的独立不良预后因素。我们的结果表明，诱导治疗后通过流式细胞术检测到的 MRD 可预测儿童 AML 患者的结局，并有助于对缓解后治疗进行分层。
In children with acute myeloid leukaemia (AML), assessment of initial treatment response is an essential prognostic factor; methods more sensitive than morphology are still under evaluation. We report on the measurement of minimal residual disease (MRD), by multicolour flow-cytometry in one centralized laboratory, in 142 children with newly diagnosed AML enrolled in the Associazione Italiana di EmatoOncologia Pediatrica-AML 2002/01 trial. At the end of the first induction course, MRD was < 0.1% in 69, 0.11% in 16 and > 1% in 51 patients. The 8-year disease-free survival (DFS) of 125 children in morphological complete remission and with MRD < 0.1%, 0.1-1% and >= 1% was 73.1 +/- 5.6%, 37.8 +/- 12.1% and 34.1 +/- 8.8%, respectively (P < 0.01). MRD was also available after the second induction course in 92/142 patients. MRD was >= 0.1% at the end of the first induction course in 36 patients; 13 reached an MRD < 0.1% after the second one and their DFS was 45.4 +/- 16.7% vs. 22.8 +/- 8.9% in patients with persisting MRD >= 0.1% (P = 0.037). Multivariate analysis demonstrated that MRD >= 0.1% after first induction course was, together with a monosomal karyotype, an independent adverse prognostic factor for DFS. Our results show that MRD detected by flow-cytometry after induction therapy predicts outcome in patients with childhood AML and can help stratifying post-remission treatment.