The prognostic significance of minimal residual disease detection after first induction treatment in adult acute lymphoblastic leukemia patients treated with autologous stem cell transplantation.
10.3760/cma.j.issn.0253-2727.2019.02.003
- VernacularTitle:成人急性淋巴细胞白血病患者首疗程化疗结束时微小残留病检测对自体造血干细胞移植预后的意义
- Author:
Zou Fang HUANG
1
;
Jie XU
;
Ming Wei FU
;
Ting Yu WANG
;
Mu HAO
;
Wei LIU
;
Lu Gui QIU
;
De Hui ZOU
Author Information
1. Department of Lymphoma Center, State Key Laboratory of Experimental Hematology, Institute of Hematology and Blood Diseases Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Tianjin 300020, China.
- Publication Type:Journal Article
- Keywords:
Hematopoietic stem cell transplantation;
Leukemia, lymphocyte, acute;
Minimal residual disease;
Prognosis
- MeSH:
Adult;
Hematopoietic Stem Cell Transplantation;
Humans;
Neoplasm, Residual;
Precursor Cell Lymphoblastic Leukemia-Lymphoma;
Prognosis;
Retrospective Studies;
Transplantation, Autologous
- From:
Chinese Journal of Hematology
2019;40(2):105-110
- CountryChina
- Language:Chinese
-
Abstract:
Objective: To investigate the prognostic significance of detection of minimal residual disease after first induction treatment (MRD(1)) in adult acute lymphoblastic leukemia (ALL) patients treated with autologous stem cell transplantation (auto-HSCT). Methods: The clinical data of 87 ALL patients who underwent auto-HSCT during February 2006 to April 2017 with MRD(1) detection data by flow cytometry were analyzed retrospectively. The relationship between MRD(1) and relapse and survival of ALL patients after auto-HSCT was studied. Results: Of 87 patients, 26 (29.9%) were MRD(1) positive. The proportion of high-risk immunophenotype (pro-B, pro-T, pre-T, mature T) was significantly higher in MRD(1)-positive patients than that in MRD(1) negative patients (34.6% vs 14.5%, P=0.038). There was no significant difference between positive and negative MRD(1) patients at age, sex, lineage (T/B), immunophenotype (standard risk/high risk), high white blood cell count (B-ALL>30×10(9)/L or T-ALL>100×10(9)/L), high-risk chromosome/gene ratio, the time from first complete remission to transplantation and pre-treatment regimen. The 5-year overall survival (OS) and leukemia-free survival (LFS) in MRD(1) negative and positive patients were 72.7% vs 47.3% (P=0.004) and 75.7% vs 29.6% (P<0.001), respectively. Multivariate analysis showed that positive MRD(1) was an independent risk factor for OS (HR=3.007, 95% CI 1.256-7.200, P=0.013) , and positive MRD(1) and high-risk immunophenotype were risk factors for LFS (HR=3.986, 95% CI 1.813-8.764, P=0.001; HR=2.981, 95% CI 1.373-6.473, P=0.006) . Conclusions: Auto-HSCT could not reverse the poor prognosis of MRD(1) positive patients. Auto-HSCT treatment is optional for patients with MRD(1) negative and maintaining MRD(1) negative status during intensive therapy.
