在同种异体造血细胞移植 (HCT) 之前通过多参数流式细胞术 (MFC) 可测量的残留病 (MRD) 可以识别急性髓性白血病 (AML) 复发的高风险患者，这种情况通常在同种异体移植后早期发生。为了检验 MFC MRD 检测对预测后期复发的作用，我们检查了 935 名患有 AML 或骨髓增生异常肿瘤 (MDS)/AML 移植且在第一次或第二次形态学缓解期间的成人，他们在 HCT 后 70 天至 100 天之间接受了骨髓重新分期研究并且在第 100 天时仍然存活并且没有复发。其中 136 名患者 (15%) 在 HCT 前有 MRD，而只有 11 名患者 (1%) 在第 70-100 天时有 MRD。在第 100 天的里程碑分析中，HCT 前和第 70-100 天 MFC MRD 均与复发（均 P<0.001）、无复发生存期（RFS；均 P<0.001）总生存期（OS；均 P<0.001）相关。 ，对于 HCT 后 MRD，多变量调整后的非复发死亡率 (P=0.001)。重要的是，虽然 136 名在 HCT 前患有 MRD 的患者中，有 126 名 (92%) 在第 70-100 天时检测为 MRD 阴性，但他们的结果低于在 HCT 前和第 70-100 天没有 MRD 的患者，3 年复发风险为40% vs. 15% (P<0.001)，3 年 RFS 为 50% vs. 72% (P<0.001)，3 年 OS 为 56% vs. 76% (P<0.001)，而 3-年 NRM 估计值相似 (P=0.53)。因此，尽管 MRD 转化率较高，但 MRDpos/MRDneg 患者的结果仍不如 MRDneg/MRDneg 患者，这表明所有 HCT 前 MRD 患者在同种异体移植后均应考虑采取先发制人的治疗策略。版权所有 © 2024 美国血液学会。

Measurable residual disease (MRD) by multiparametric flow cytometry (MFC) before allogeneic hematopoietic cell transplantation (HCT) identifies patients at high risk of acute myeloid leukemia (AML) relapse, often occurring early after allografting. To examine the role of MFC MRD testing for the prediction of later relapses, we examined 935 adults with AML or myelodysplastic neoplasm (MDS)/AML transplanted in first or second morphologic remission who underwent bone marrow restaging studies between day 70 and 100 post-HCT and were alive and without relapse by day +100. Of these 136 (15%) had MRD before HCT, whereas only 11 (1%) had MRD at day +70-100. In day +100 landmark analyses, pre-HCT and day +70-100 MFC MRD were both associated with relapse (both P<0.001), relapse-free survival (RFS; both P<0.001) overall survival (OS; both P<0.001), and, for post-HCT MRD, non-relapse mortality (P=0.001) after multivariable adjustment. Importantly, while 126 of the 136 patients (92%) with MRD before HCT tested negative for MRD at day +70-100, their outcomes were inferior to those without MRD before HCT and at day +70-100, with 3-year relapse risk of 40% vs. 15% (P<0.001), 3-year RFS of 50% vs. 72% (P<0.001), and 3-year OS of 56% vs. 76% (P<0.001), whereas 3-year NRM estimates were similar (P=0.53). Thus, despite high MRD conversion rates, outcomes for MRDpos/MRDneg patients are inferior to MRDneg/MRDneg patients, suggesting all patients with pre-HCT MRD should be considered for pre-emptive therapeutic strategies after allografting.Copyright © 2024 American Society of Hematology.