Positive MRD suggests a poor prognosis for ALL patients with or above CR2 before allogeneic transplantation
10.3760/cma.j.cn114452-20210814-00504
- VernacularTitle:微小残留病阳性提示异基因移植前疾病状态处于完全缓解2及以上的急性淋巴细胞白血病患者的预后欠佳
- Author:
Zhidong WANG
1
;
Siqi LI
;
Yuqian SUN
;
Chenhua YAN
;
Fengrong WANG
;
Xiaodong MO
;
Meng LYU
;
Xiaosu ZHAO
;
Wei HAN
;
Huan CHEN
;
Yuhong CHEN
;
Yazhe WANG
;
Yanrong LIU
;
Yu WANG
;
Lanping XU
;
Xiaohui ZHANG
;
Kaiyan LIU
;
Xiaojun HUANG
;
Yingjun CHANG
Author Information
1. 北京大学人民医院血液科，北京大学血液病研究所，国家血液系统疾病临床医学研究中心，造血干细胞移植治疗血液病北京市重点实验室，北京 100044
- Keywords:
Acute lymphoblastic leukemia;
Minimal residual disease;
Allogeneic stem cell transplantation;
Relapse
- From:
Chinese Journal of Laboratory Medicine
2021;44(12):1145-1152
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To investigate the value of minimal residual disease (MRD) in prediction of prognosis in acute lymphoblastic leukemia (ALL) patients with or above complete remission 2 (CR2) underwent.Methods:A retrospective analysis was performed on 201 ALL patients who received allogeneic stem cell transplantation (allo-SCT) and pretransplant disease status ≥CR2 in Peking University People′s Hospital from January 2009 to December 2018. MRD was measured by multi-parameter flow cytometry at 1 month before transplantation and 1 month, 2 months, 3 months, 4 months, 6 months, 9 months or 12 months after transplantation. To investigate the influence of dynamic changes of MRD before and after transplantation on prognosis.Results:201 ALL patients, including 126 males and 75 females, with a median age of 18 years. The 3-year cumulative incidence of relapse (CIR), non-relapse mortality (NRM), leukemia-free survival (LFS) and overall survival (OS) of all cases were 34%, 16%, 50%, and 56%, respectively. Positive pre-SCT MRD patients with higher 3-year CIR (47% vs 26%, P=0.003), lower 3-year LFS (40% vs 55%, P=0.047) and OS (42% vs 60%, P=0.065) than those with negative one. Subjects with positive post-MRD had higher 3-year CIR (73% vs 22%, P<0.001) and lower 3-year LFS (28% vs 56%, P=0.005) and OS (32% vs 60%, P=0.040) compared with those with negative one. Multivariate analysis showed that both pre-MRD and post-MRD were associated with higher CIR ( HR=1.823, P=0.018; HR=3.474, P<0.001), lower LFS ( HR=1.779, P=0.007; HR=2.185, P=0.001) and OS ( HR=1.609, P=0.034; HR=1.970, P=0.001). Negative pre-and post-SCT MRD group had lower 3-year CIR (17%, 42%, 82%; P<0.001) and higher 3-year LFS (61%, 44%, 18%; P<0.001) and OS (63%, 47%, 27%; P<0.001) compared with those unrisen post-SCT MRD group, and increased post-SCT MRD group. Multivariate analysis showed that pre-and post-SCT MRD dynamics were associated with CIR, LFS and OS ( P<0.01 for all) independently. The pre-and post-SCT MRD dynamics could better distinguish CIR (C=0.669) from that of pre-SCT MRD (C=0.587) and post-SCT MRD (C=0.629). Conclusion:Our data suggest that pre-SCT MRD, post-SCT MRD and the dynamic peri-SCT MRD could be used to predict transplant outcome of ALLpatients with or above CR2 who underwent allo-SCT.
