Recommendations for reporting post-transplant relapse in AML
Recommendations for reporting post-transplant relapse in AML
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DOI：
10.1038/bmt.2017.227
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发表时间：
2018-02
影响因子：
4.8
通讯作者：
Armin Rashidi;Michael A. Linden;M. Percival;B. Sandmaier;S. Devine;D. Weisdorf
中科院分区：
文献类型：
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作者：
Armin Rashidi;Michael A. Linden;M. Percival;B. Sandmaier;S. Devine;D. Weisdorf
复发仍然是AML患者异基因造血细胞移植(allo-HCT)后死亡的主要原因。我们目前先进的分子和基因组技术使我们能够在从单个突变到形态明显的原始细胞的不同水平上深入探讨白血病的清除、持久性和再现。1随着国家和国际数据库研究的趋势日益增强，在报告复发方面有明确的定义和统一的共识至关重要。如果没有这些，大规模的数据库研究将不会完全可靠。这篇简短的文章的目的是就如何报告急性髓细胞白血病患者的红细胞压积后复发提供具体的建议。HCT后的设置是独一无二的，因为患者通常受到更密切的监测，并接受更多的测试(常规或排除复发)，从而生成更广泛的潜在与复发相关的数据。此外，停用免疫抑制药物和供者淋巴细胞输注等干预措施是针对HCT的。为HCT的独特特征量身定做复发后HCT的定义是至关重要的。血液学复发被定义为⩾5%的成髓细胞形态上的重现，其免疫表型为异常的流式细胞术定义的或类似于诊断时的原始免疫表型，在上一次CR后外周血和/或骨髓中。我们不鼓励使用流式细胞术报告o5%的爆炸性细胞或疑似爆炸性细胞。
Relapse continues to be the primary cause of death after allogeneic hematopoietic cell transplantation (allo-HCT) in patients with AML. Our current sophisticated molecular and genomic techniques have enabled us to deeply explore the clearance, persistence and reappearance of leukemia at various levels ranging from individual mutations to morphologically apparent blasts. 1 With the growing trends in national and international database research, it is of paramount importance to have clear definitions and a uniform consensus in reporting relapse. Without these in place, large-scale database research would not be fully reliable. The goal of this brief piece is to provide specific recommendations on how to report post-HCT relapse in AML. The post-HCT setting is unique because patients are typically monitored more closely and undergo more testing (routinely or to rule out relapse), thus generating a wider array of data potentially relevant to relapse. In addition, interventions such as withdrawal of immunosuppression and donor lymphocyte infusion are specific to HCT. It is critical to have definitions of relapse post HCT tailored for unique characteristics of HCT. We propose the following categories to clarify the definitions of relapse post HCT (Table 1).Hematological relapse is defined as the morphologic reappearance of⩾ 5% myeloblasts, either with an aberrant flow cytometrydefined immunophenotype or one resembling the blast immunophenotype at diagnosis, in the peripheral blood and/or bone marrow after a previous CR. We discourage reporting cases with o5% blasts or those with suspected blasts by flow cytometry