Minimal Residual Disease Testing After Induction Chemotherapy for Acute Myeloid Leukemia: Moving Beyond Prognostication?
Menée à partir d'échantillons de moelle osseuse et/ou de sang prélevés sur 2 450 patients atteints d'une leucémie myéloïde aiguë ou présentant un syndrome myélodysplasique à haut risque (âge : 16 ans ou plus), cette étude met en évidence l'intérêt de déterminer, à l'aide de la cytométrie en flux multiparamétrique, la présence d'une maladie résiduelle minimale après une chimiothérapie d'induction pour identifier, parmi les patients ne présentant pas de mutation NPM1 et dont le risque de récidive est dit "standard", ceux pouvant bénéficier d'une greffe de cellules souches hématopoïétiques
Thirty years ago, the term minimal residual disease (MRD) was coined to denote the acute myeloid leukemia (AML) cells that survive seemingly successful remission-induction chemotherapy, hide below the cytomorphological detection limit, and are responsible for relapse.1 It was hypothesized that decreasing the detection threshold for leukemic cells would quantify treatment efficacy, establish a new prognostic factor, and help guide decisions regarding treatment continuation (or discontinuation) and assignment to hematopoietic cell transplantation (HCT).1 Fast forward to 2018. Reasonably sensitive assays are now available to test for MRD on the basis of immunophenotypic or molecular leukemia cell abnormalities, which are applicable to most people with AML.2 Despite inherent limitations of these assays, many studies reported robust correlations between positive MRD tests and higher relapse rates, documenting value for risk prognostication as postulated.2 For instance, after induction cycle 1, cumulative relapse risk estimates have ranged from 15% to 25% for patients in morphologic complete remission (CR) with a negative MRD test (MRDneg CR) and 40% to 65% for those in morphologic CR with a positive MRD test (MRDpos CR).3
Journal of Clinical Oncology , éditorial en libre accès, 2017