移植前后可测量残留病（MRD）水平与较差的移植结局相关，造血干细胞移植后可测量残留病（HSCT后MRD）在确定风险方面比造血干细胞移植前具有更高的预后价值可测量的残留病灶（HSCT 前 MRD）。然而，只有少数工作致力于急性淋巴细胞白血病 (ALL) 患者 HSCT 后 MRD 阳性的危险因素。本研究评估接受异基因造血干细胞移植（allo-HSCT）的ALL患者HSCT后MRD阳性的危险因素。共纳入2009年1月至2019年12月北京大学人民医院的1683例ALL患者进行评估HSCT 后 MRD 的累积发生率。 Cox 比例风险回归模型是针对事件时间结果建立的。进行多变量分析以确定单变量分析中的独立影响因素。无论是在总患者中还是在T细胞ALL或B细胞ALL、儿童或成人、人类白细胞抗原匹配的兄弟供体移植或半相合SCT亚组中，阳性预- HSCT MRD 是 HSCT 后 MRD 阳性的危险因素（所有 P <0.001）。疾病状态（完全缓解 1 [CR1] 与≥CR2）也是所有患者以及 B 细胞 ALL、儿童或半相合 SCT 亚组中 HSCT 后 MRD 阳性的危险因素（P = 0.027；P = 0.003） ；P = 0.035；P = 0.003）。使用 HSCT 前 MRD 和疾病状态变量制定 HSCT 后 MRD 阳性风险评分。对于得分为 0、1 和 2-3 的受试者，HSCT 后 MRD 阳性的累积发生率分别为 12.3%、25.1% 和 38.8%（P <0.001）。多变量分析证实了风险评分与 HSCT 后 MRD 阳性和复发的累积发生率以及无白血病生存期和总生存期之间的关联。我们的结果表明，阳性前 MRD 和疾病状态是 HSCT 后 MRD 阳性和复发的累积发生率的两个独立危险因素。 -接受 allo-HSCT 的 ALL 患者的 HSCT MRD 阳性。版权所有 © 2024 中华医学会，由 Wolters Kluwer, Inc. 根据 CC-BY-NC-ND 许可制作。

The level of measurable residual disease (MRD) before and after transplantation is related to inferior transplant outcomes, and post-hematopoietic stem cell transplantation measurable residual disease (post-HSCT MRD) has higher prognostic value in determining risk than pre-hematopoietic stem cell transplantation measurable residual disease (pre-HSCT MRD). However, only a few work has been devoted to the risk factors for positive post-HSCT MRD in patients with acute lymphoblastic leukemia (ALL). This study evaluated the risk factors for post-HSCT MRD positivity in patients with ALL who underwent allogeneic hematopoietic stem cell transplantation (allo-HSCT).A total of 1683 ALL patients from Peking University People's Hospital between January 2009 and December 2019 were enrolled to evaluate the cumulative incidence of post-HSCT MRD. Cox proportional hazard regression models were built for time-to-event outcomes. Multivariate analysis was performed to determine independent influencing factors from the univariate analysis.Both in total patients and in T-cell ALL or B-cell ALL, pediatric or adult, human leukocyte antigen-matched sibling donor transplantation or haploidentical SCT subgroups, positive pre-HSCT MRD was a risk factor for post-HSCT MRD positivity (P <0.001 for all). Disease status (complete remission 1 [CR1] vs. ≥CR2) was also a risk factor for post-HSCT MRD positivity in all patients and in the B cell-ALL, pediatric, or haploidentical SCT subgroups (P = 0.027; P = 0.003; P = 0.035; P = 0.003, respectively). A risk score for post-HSCT MRD positivity was developed using the variables pre-HSCT MRD and disease status. The cumulative incidence of post-HSCT MRD positivity was 12.3%, 25.1%, and 38.8% for subjects with scores of 0, 1, and 2-3, respectively (P <0.001). Multivariate analysis confirmed the association of the risk score with the cumulative incidence of post-HSCT MRD positivity and relapse as well as leukemia-free survival and overall survival.Our results indicated that positive pre-MRD and disease status were two independent risk factors for post-HSCT MRD positivity in patients with ALL who underwent allo-HSCT.Copyright © 2024 The Chinese Medical Association, produced by Wolters Kluwer, Inc. under the CC-BY-NC-ND license.