Minimal residual disease surveillance in chronic lymphocytic leukemia by fluorescence-activated cell sorting.
Achievement of complete response (CR) to therapy in chronic lymphocytic leukemia (CLL) has become a feasible goal, directly correlating with prolonged survival. It has been established that the classic definition of CR actually encompasses a variety of disease loads, and more sensitive multiparameter flow cytometry and polymerase chain reaction methods can detect the disease burden with a much higher sensitivity. Detection of malignant cells with a sensitivity of 1 tumor cell in 10,000 cells (10(-4)), using the abovementioned sophisticated techniques, is the current cutoff for minimal residual disease (MRD). Tumor burdens lower than 10(-4) are defined as MRD-negative. Several studies in CLL have determined the achievement of MRD negativity as an independent favorable prognostic factor, leading to prolonged disease-free and overall survival, regardless of the treatment protocol or the presence of other pre-existing prognostic indicators. Minimal residual disease evaluation using flow cytometry is a sensitive and applicable approach which is expected to become an integral part of future prospective trials in CLL designed to assess the role of MRD surveillance in treatment tailoring.
Department of Hematology and Bone Marrow Transplantation, Rambam Health Care Campus, Haifa, Israel ; Bruce Rappaport Faculty of Medicine, Technion, Israel Institute of Technology, Haifa, Israel.
Shimrit
S
Ringelstein-Harlev
Department of Hematology and Bone Marrow Transplantation, Rambam Health Care Campus, Haifa, Israel.
Riva
R
Fineman
ASO-PCR; chronic lymphocytic leukemia; flow cytometry; minimal residual disease; prognosis; survival