Prognostic value of high-sensitivity measurable residual disease assessment after front-line chemoimmunotherapy in chronic lymphocytic leukemia.
Fiche publication
Date publication
septembre 2020
Journal
Leukemia
Auteurs
Membres identifiés du Cancéropôle Est :
Pr FEUGIER Pierre, Dr DEBLIQUIS Agathe, Dr DRENOU Bernard
Tous les auteurs :
Letestu R, Dahmani A, Boubaya M, Baseggio L, Campos L, Chatelain B, Debliquis A, Drénou B, Jacob MC, Legac E, Le Garff-Tavernier M, Lhoumeau AC, Quiney C, Robillard N, Ticchioni M, Aanei C, Katsahian S, Delepine R, Vaudaux S, Rouillé V, Béné MC, Dartigeas C, Van Den Neste E, Leprêtre S, Feugier P, Cartron G, Leblond V, Lévy V, Cymbalista F,
Lien Pubmed
Résumé
Measurable residual disease (MRD) status is widely adopted in clinical trials in patients with chronic lymphocytic leukemia (CLL). Findings from FILO group trials (CLL2007FMP, CLL2007SA, CLL2010FMP) enabled investigation of the prognostic value of high-sensitivity (0.7 × 10) MRD assessment using flow cytometry, in blood (N = 401) and bone marrow (N = 339), after fludarabine, cyclophosphamide, and rituximab (FCR)-based chemoimmunotherapy in a homogeneous population with long follow-up (median 49.5 months). Addition of low-level positive MRD < 0.01% to MRD ≥ 0.01% increased the proportion of cases with positive MRD in blood by 39% and in bone marrow by 27%. Compared to low-level positive MRD < 0.01%, undetectable MRD was associated with significantly longer progression-free survival (PFS) when using blood (72.2 versus 42.7 months; hazard ratio 0.40, p = 0.0003), but not when using bone marrow. Upon further stratification, positive blood MRD at any level, compared to undetectable blood MRD, was associated with shorter PFS irrespective of clinical complete or partial remission, and a lower 5-year PFS rate irrespective of IGHV-mutated or -unmutated status (all p < 0.05). In conclusion, high-sensitivity (0.0007%) MRD assessment in blood yielded additional prognostic information beyond the current standard sensitivity (0.01%). Our approach provides a model for future determination of the optimal MRD investigative strategy for any regimen.
Référence
Leukemia. 2020 Sep 15;: