移植期间的难题:利用MRD导向的方法优化维持疗法.
Suravi Raychaudhuri1,2, Ryan D Cassaday1,2, Mary-Elizabeth M Percival1,2
1Division of Hematology and Oncology, Department of Medicine, University of Washington, Seattle, WA.
Hematology. American Society of Hematology. Education Program
|December 5, 2025
概括
在急性白血病中检测可测量的残留疾病 (MRD) 的进展使得移植后的监测成为可能. 针对性治疗对MRD阳性患者有希望,但最佳干预需要进一步研究.
科学领域:
- 血液学 血液学 血液学
- 分子生物学分子生物学
- 在瘤学瘤学.
背景情况:
- 分子洞察力改善了在急性白血病中检测可测残留疾病 (MRD) 的检测.
- 下一代测序和PCR测定检测到MRD的水平低至10^-6.
- 在全源造血细胞移植 (HCT) 周围检测到的MRD与糟糕的结果和复发风险相关.
研究的目的:
- 审查维持治疗在急性白血病中的作用,重点关注HCT前后的MRD阳性患者.
- 讨论针对特定急性髓性白血病 (AML) 和急性淋巴细胞白血病 (ALL) 背景下针对MRD的当前策略.
主要方法:
- 对急性白血病中MRD检测和治疗研究的文献综述.
- 对接受HCT或其后接受MRD阳性患者的治疗策略的分析.
- 专注于特定的药物,如阿扎西蒂丁,吉尔特里尼布,索拉费尼布,布利纳图莫马布和氨酸激酶抑制剂.
主要成果:
- 在HCT后,阿扎西提丁可能有利于MRD阳性AML.
- 吉尔特里尼布和索拉费尼布是基于证据的MRD在FLT3突变的AML后HCT.
- 布利纳图莫马布在Ph+和Ph-阴性ALL中有效消除MRD;TKI用于HCT后的Ph+ALL.
结论:
- 在准急性白血病周边HCT.MRD方面取得了显著进展.
- 对于许多患者来说,围绕HCTMRD的最佳持续时间和干预类型仍未确定.
- 需要进一步的研究,以建立对MRD管理的最终治疗指南.
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