Dynamics of minimal residual disease defines a novel risk-classification and the role of allo-HSCT in adult Ph-negative B-cell acute lymphoblastic leukemia
Dynamics of minimal residual disease defines a novel risk-classification and the role of allo-HSCT in adult Ph-negative B-cell acute lymphoblastic leukemia
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DOI：
10.1080/10428194.2022.2115841
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发表时间：
2022-09-12
影响因子：
2.6
通讯作者：
Zhou, Hongsheng
中科院分区：
文献类型：
--
作者：
Cai, Zihong;Liu, Yiqian;Zhou, Hongsheng
急性淋巴细胞白血病（ALL）患者微小残留病（MRD）的预后是确定的。然而，实施动态MRD的风险分类和异基因造血干细胞移植（allo-HSCT）的决策仍然模糊。在本研究中，我们收集了来自精确分类导向靶向总治疗ALL-2016（PDT-ALL-2016）队列的Ph阴性B-ALL患者（n = 134）的多参数流式细胞术（MFC）-MRD数据，并将其分层为高风险（HR）、中等风险（MR）和标准风险（SR）组。中位随访时间为3.65年（95% CI：3.037-4.263），HR的3年OS率为51.8 +/- 8.3%，而MR为61.5 +/- 10.8%（p = 0.472），SR为73.3 +/- 5.9%（p = 0.006）。多因素分析显示综合动态MRD是影响总生存率的独立因素。与儿科启发化疗相比，allo-HSCT显著改善了HR队列的生存率（p < 0.001），但在MR和SR中没有改善。最后，我们的研究表明，综合动态MRD定义了一种新的风险分类标准，并强调了allo-HSCT在Ph阴性ALL成人患者中的获益。
The prognosis of minimal residual disease (MRD) in acute lymphoblastic leukemia (ALL) patients is well established. However, the implementation of dynamic MRD for risk classification and decision-making for allogeneic hematopoietic stem cell transplantation (allo-HSCT) remains vague. In this study, we collected multiparameter flow cytometry (MFC)-MRD data of Ph-negative B-ALL patients (n = 134) from the Precision-Classification-Directed-Target-Total-Therapy-ALL-2016 (PDT-ALL-2016) cohort and stratified it into high-(HR), medium-(MR), and standard-risk (SR) groups. With a median of 3.65 years follow-up (95% CI: 3.037-4.263), 3-year OS rate was 51.8 +/- 8.3% in HR, compared with MR 61.5 +/- 10.8% (p = 0.472), and SR 73.3 +/- 5.9% (p = 0.006). Multivariate analysis shows that integrated dynamic MRD is an independent factor for overall survival. Compared to pediatric-inspired chemotherapy, allo-HSCT significantly improves the survival of the HR cohort (p < 0.001), but not in MR and SR. Finally, our study suggests that integrated dynamic MRD defines a novel risk-classification criteria and highlights the benefits of allo-HSCT in adult patients with Ph-negative ALL.