Minimal Residual Disease Assessment and Risk-based Therapy in Acute Lymphoblastic Leukemia
| Autor: | Piera Viero, Francesca Gianni, Rosaria Sancetta, Francesca Carobolante, Paola Stefanoni, Renato Bassan, Tamara Intermesoli, Alessandro Rambaldi, Elena Maino, Manuela Tosi, Annamaria Scattolin, Orietta Spinelli |
|---|---|
| Rok vydání: | 2017 |
| Předmět: |
Adult
Oncology Cancer Research medicine.medical_specialty Neoplasm Residual medicine.drug_class Lymphoblastic Leukemia medicine.medical_treatment Monoclonal antibody Peripheral blood mononuclear cell Disease-Free Survival Flow cytometry 03 medical and health sciences 0302 clinical medicine Risk Factors hemic and lymphatic diseases Internal medicine Antineoplastic Combined Chemotherapy Protocols Outcome Assessment Health Care medicine Humans Child Chemotherapy medicine.diagnostic_test business.industry Hematopoietic Stem Cell Transplantation Hematology Precursor Cell Lymphoblastic Leukemia-Lymphoma Minimal residual disease Chimeric antigen receptor Transplantation 030220 oncology & carcinogenesis Immunology business 030215 immunology |
| Zdroj: | Clinical Lymphoma Myeloma and Leukemia. 17:S2-S9 |
| ISSN: | 2152-2650 |
| DOI: | 10.1016/j.clml.2017.02.019 |
| Popis: | The study of minimal residual disease (MRD) in adult patients with acute lymphoblastic leukemia (ALL) allows a greater refinement of the individual risk classification and is the best support for risk-specific therapy with or without allogeneic hematopoietic cell transplantation (HCT). Using case-specific sensitive molecular probes or multiparametric flow cytometry on marrow samples obtained from the end of induction until midconsolidation, MRD assays can detect up to 1 leukemic cell of 10,000 total mononuclear cells (sensitivity, 0.01%; ie, ≥10 4 ). This cutoff, presently bound to technical limitations and subject to improvement, reflects the individual chemosensitivity and is strongly correlated with treatment outcome. The chance for cure is approximately 70% in the MRD-negative subset but only 20% to 30% in MRD-positive patients, in any diagnostic and risk subset. As shown by prospective trials from Germany, Italy, Spain, and France-Switzerland-Belgium, approximately 50% to 70% of unselected adult patients with Philadelphia-negative ALL achieve and maintain an early MRD response, whereas the remainder do not, including a substantial proportion of clinically standard-risk patients, and require an HCT to avert at least partially the risk of relapse. Along with the diffusion of more effective "pediatric-inspired" chemotherapy programs, the MRD analysis is an integral part of a modern management strategy, guiding the decision process to transplant or not, in which case nonrelapse mortality using HCT in first remission—still 10% to 20%—is totally abolished. The use of new agents such as monoclonal antibodies, small inhibitors, and chimeric antigen receptor T cells is opening a new era of MRD-directed therapies, that will further increase survival rates. |
| Databáze: | OpenAIRE |
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