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- Title
Minimal residual disease monitoring and preemptive immunotherapy in myelodysplastic syndrome after allogeneic hematopoietic stem cell transplantation.
- Authors
Mo, Xiao-Dong; Qin, Ya-Zhen; Zhang, Xiao-Hui; Xu, Lan-Ping; Wang, Yu; Yan, Chen-Hua; Chen, Huan; Chen, Yu-Hong; Han, Wei; Wang, Feng-Rong; Wang, Jing-Zhi; Liu, Kai-Yan; Huang, Xiao-Jun
- Abstract
This study investigated the efficacy of minimal residual disease (MRD) monitoring and MRD-directed preemptive immunotherapy in high-risk myelodysplastic syndrome (MDS) patients who received allogeneic hematopoietic stem cell transplantation (HSCT). MRD assessment consisted of Wilms' tumor gene 1 (WT1) detection with PCR and leukemia-associated immunophenotypic pattern examination with multiparameter flow cytometry (FCM). Post-HSCT, 31 patients were positive for WT1, and 8, for FCM; positivity for WT1 (18.6 vs. 6.1 %, P = 0.040) or FCM (62.5 vs. 3.6 %, P < 0.001) indicated a higher 2-year relapse rate. Twenty-one patients met our combined criteria for MRD, and the presence of MRD was associated with a higher 2-year relapse rate (27.3 vs. 4.5 %, P = 0.003). Preferentially expressed antigen of melanoma (PRAME) expression alone was not an appropriate MRD marker; however, it suggested that the MRD-positive patients may fail to respond to preemptive immunotherapy. In patients positive for both PRAME and MRD, the relapse rate was 60 % despite preemptive immunotherapy. Multivariate analysis confirmed the association between the increased relapse rate and positivity for both PRAME and MRD (hazard ratio = 42.8, P = 0.001). MRD monitoring predicted relapse in high-risk MDS post-HSCT patients, and PRAME- and MRD-positive patients did not benefit from preemptive immunotherapy.
- Subjects
MYELODYSPLASTIC syndromes; HEMATOPOIETIC stem cell transplantation; GRAFT versus host disease; BONE marrow diseases; DISEASE relapse; STEM cell transplantation; THERAPEUTICS; IMMUNOLOGY; MYELODYSPLASTIC syndromes treatment; CARCINOGENESIS; CANCER relapse; FLOW cytometry; GENES; HOMOGRAFTS; IMMUNOPHENOTYPING; IMMUNOTHERAPY; MULTIVARIATE analysis; HEALTH outcome assessment; POLYMERASE chain reaction; PROGNOSIS; PROTEINS; TUMOR antigens; PROPORTIONAL hazards models; REVERSE transcriptase polymerase chain reaction; KAPLAN-Meier estimator; METABOLISM
- Publication
Annals of Hematology, 2016, Vol 95, Issue 8, p1233
- ISSN
0939-5555
- Publication type
journal article
- DOI
10.1007/s00277-016-2706-y