Peripheral blood haploidentical hematopoietic stem cell transplantation for treatment of acute lymphoblastic leukemia in adults: monitoring minimal residual diseases to intervene recurrence / 中国组织工程研究

ABSTRACT

BACKGROUND: Recurrence of acute leukemia after hematopoietic stem cell transplantation is one of the major problems affecting the long-term survival of patients. Early intervention to prevent ALL recurrence after transplantation can improve disease-free survival, overall survival and reduce post-transplant mortality. Monitoring of minimal residual disease (MRD) by flow cytometry and PCR-based molecular biology techniques is a widely reliable and practicable method. OBJECTIVE: To dynamically monitor the MRD level of acute lymphoblastic leukemia after peripheral blood haploidentical hematopoietic stem cell transplantation and to explore its implications for predicting early relapse. METHODS: A retrospective study was conducted in 53 patients with acute lymphoblastic leukemia who had underwgone peripheral blood haploidentical hematopoietic stem cell transplantation at the First Affiliated Hospital of Zhengzhou University from June 2011 to June 2017. The patients were followed up for postoperative 1, 3, 6, 12 months to observe the relation between MRD levels and relapse after transplantation. RESULTS AND CONCLUSION: (1) The disease-free survival rate of MRD positive group and MRD negative group were 20.0% and 65.8%, respectively; and the overall survival rates were 50.8% and 68.9% in the two groups, respectively. There were significant differences between two groups. (2) Among 16 MRD positive patients accepting clinical intervention after transplantation, 4 patients presented with MRD negative and had no recurrence. (3) Eleven hematologic recurrence patients were given tyrosine kinase inhibitor-targeted therapy, chemotherapy, donor lymphocytes Infusion and secondary transplantation, but they eventually died. The median time from the discovery of MRD positive to hematologic recurrence was 100 (7-190) days, and during this period. Clinical intervention was confirmed to extend the recurrence time. In this study, one case refused clinical intervention, and eventually died of recurrence. Our findings indicate that dynamic monitoring of the MRD level in acute lymphoblastic leukemia patients after peripheral blood haploidentical transplantation can predict recurrence, by which the patients can be given early intervention to reduce the risk of recurrence and improve disease-free survival and overall survival.