Challenging the Value of Minimal Residual Disease in Predicting Outcome of Patients With Chronic Lymphocytic Leukemia
Menée à partir d'échantillons de moelle osseuse et de sang périphérique prélevés sur 211 patients atteints d'une leucémie lymphoïde chronique (durée médiane de suivi : 34 mois), cette étude analyse, en fonction du traitement reçu (ibrutinib + vénétoclax ou chlorambucil + obinutuzumab), la relation entre le niveau de maladie résiduelle après la fin du traitement et la survie sans progression à 1 an
Improvements in treatments for patients with chronic lymphocytic leukemia (CLL) can allow therapeutic eradication of any detectable disease by even the most sensitive methods. Intuition dictates that patients who do not have any detectable minimal residual disease (MRD) after treatment should have a longer progression-free survival (PFS) than those who have residual disease after therapy. Clinical studies evaluating for MRD after therapy and assessing its relationship with PFS provided evidence that clearance of MRD may supplant other metrics for assessing the response to therapy. For example, patients who have undetectable MRD (uMRD) after chemoimmunotherapy (CIT), but who achieved only a partial response by International Workshop on Chronic Lymphocytic Leukemia criteria,1 had a longer PFS than patients who had achieved a complete response, but had detectable MRD after therapy.2 Similar observations subsequently were made for patients treated with venetoclax and anti-CD20 monoclonal antibodies (mAb).3,4 Moreover, the relative level of MRD detected after therapy appeared to correlate inversely with the length of disease remission. This has led to the assumption that clearance of detectable MRD may be among the most consequential surrogate markers for a prolonged PFS after fixed-duration (FD) therapy.
Journal of Clinical Oncology , éditorial en libre accès, 2022