Minimal residual disease prior to allogeneic hematopoietic cell transplantation in acute myeloid leukemia: a meta-analysis

被引:222
作者
Buckley, Sarah A. [1 ]
Wood, Brent L. [2 ]
Othus, Megan [3 ]
Hourigan, Christopher S. [4 ]
Ustun, Celalettin [5 ]
Linden, Michael A. [6 ]
DeFor, Todd E. [7 ]
Malagola, Michele [8 ]
Anthias, Chloe [9 ,10 ]
Valkova, Veronika [11 ]
Kanakry, Christopher G. [12 ,13 ]
Gruhn, Bernd [14 ]
Buccisano, Francesco [15 ]
Devine, Beth [16 ,17 ,18 ]
Walter, Roland B. [19 ,20 ,21 ]
机构
[1] Univ Washington, Hematol Oncol Fellowship Program, Seattle, WA 98195 USA
[2] Univ Washington, Dept Lab Med, Div Hematopathol, Seattle, WA 98195 USA
[3] Fred Hutchinson Canc Res Ctr, Div Publ Hlth Sci, 1124 Columbia St, Seattle, WA 98104 USA
[4] NHLBI, Hematol Branch, NIH, Bethesda, MD 20892 USA
[5] Univ Minnesota, Dept Med, Div Hematol Oncol & Transplantat, Box 736 UMHC, Minneapolis, MN 55455 USA
[6] Univ Minnesota, Dept Lab Med & Pathol, Div Hematopathol, Minneapolis, MN 55455 USA
[7] Univ Minnesota, Masonic Canc Ctr, Biostat & Bioinformat Core, Minneapolis, MN USA
[8] Univ Brescia, Unit Blood Dis & Stem Cell Transplantat, AO Spedali Civili, Brescia, Italy
[9] Anthony Nolan Res Inst, London, England
[10] Royal Marsden Hosp, London, England
[11] Inst Hematol & Blood Transfus, Prague, Czech Republic
[12] Johns Hopkins Univ, Sch Med, Sidney Kimmel Comprehens Canc Ctr, Baltimore, MD USA
[13] NCI, Expt Transplantat & Immunol Branch, Ctr Canc Res, NIH, Bethesda, MD 20892 USA
[14] Jena Univ Hosp, Dept Pediat, Jena, Germany
[15] Fdn Policlin Tor Vergata, Dept Hematol, Rome, Italy
[16] Univ Washington, Pharmaceut Outcomes Res & Policy Program, Seattle, WA 98195 USA
[17] Univ Washington, Dept Hlth Serv, Seattle, WA 98195 USA
[18] Univ Washington, Dept Biomed Informat, Seattle, WA 98195 USA
[19] Fred Hutchinson Canc Res Ctr, Div Clin Res, 1124 Columbia St, Seattle, WA 98104 USA
[20] Univ Washington, Dept Med, Div Hematol, Seattle, WA 98195 USA
[21] Univ Washington, Dept Epidemiol, Seattle, WA 98195 USA
基金
美国国家卫生研究院;
关键词
WT1; GENE-EXPRESSION; FLOW-CYTOMETRY; REDUCED-INTENSITY; PROGNOSTIC IMPACT; CHILDREN; TIME; RECOMMENDATIONS; REMISSION; DIAGNOSIS; CRITERIA;
D O I
10.3324/haematol.2016.159343
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Minimal residual disease prior to allogeneic hematopoietic cell transplantation has been associated with increased risk of relapse and death in patients with acute myeloid leukemia, but detection methodologies and results vary widely. We performed a systematic review and meta-analysis evaluating the prognostic role of minimal residual disease detected by polymerase chain reaction or multiparametric flow cytometry before transplant. We identified 19 articles published between January 2005 and June 2016 and extracted hazard ratios for leukemia-free survival, overall survival, and cumulative incidences of relapse and non-relapse mortality. Pre-transplant minimal residual disease was associated with worse leukemia-free survival (hazard ratio=2.76 [1.90-4.00]), overall survival (hazard ratio=2.36 [1.73-3.22]), and cumulative incidence of relapse (hazard ratio=3.65 [2.53-5.27]), but not nonrelapse mortality (hazard ratio=1.12 [0.81-1.55]). These associations held regardless of detection method, conditioning intensity, and patient age. Adverse cytogenetics was not an independent risk factor for death or relapse. There was more heterogeneity among studies using flow cytometry-based than WT1 polymerase chain reaction-based detection (I-2=75.1% vs. <0.1% for leukemia-free survival, 67.8% vs. <0.1% for overall survival, and 22.1% vs. <0.1% for cumulative incidence of relapse). These results demonstrate a strong relationship between pre-transplant minimal residual disease and post-transplant relapse and survival. Outcome heterogeneity among studies using flow-based methods may underscore site-specific methodological differences or differences in test performance and interpretation.
引用
收藏
页码:865 / 873
页数:9
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