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:
Zoufang HUANG
1
;
Jie XU
;
Mingwei FU
;
Tingyu WANG
;
Mu HAO
;
Wei LIU
;
Lugui QIU
;
Dehui 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:
Leukemia, lymphocyte, acute;
Minimal residual disease;
Prognosis;
Hematopoietic stem cell transplantation
- 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 (MRD1) 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 MRD1 detection data by flow cytometry were analyzed retrospectively. The relationship between MRD1 and relapse and survival of ALL patients after auto-HSCT was studied.
Results:Of 87 patients, 26 (29.9%) were MRD1 positive. The proportion of high-risk immunophenotype (pro-B, pro-T, pre-T, mature T) was significantly higher in MRD1-positive patients than that in MRD1 negative patients (34.6% vs 14.5%, P=0.038). There was no significant difference between positive and negative MRD1 patients at age, sex, lineage (T/B), immunophenotype (standard risk/high risk), high white blood cell count (B-ALL>30×109/L or T-ALL>100×109/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 MRD1 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 MRD1 was an independent risk factor for OS (HR=3.007, 95% CI 1.256-7.200, P=0.013) , and positive MRD1 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 MRD1 positive patients. Auto-HSCT treatment is optional for patients with MRD1 negative and maintaining MRD1 negative status during intensive therapy.
