Measurable residual disease in pediatric acute myeloid leukemia: a systematic review

<b>Introduction</b>: A systematic review was performed to assess the prognostic value of Measurable Residual Disease (MRD) during treatment, for relapse and overall survival in pediatric acute myeloid leukemia (AML). <b>Areas covered</b>: A systematic search of available literature was performed to identify original full-text articles concerning MRD as prognostic for relapse and survival in pediatric AML. Thirteen studies were included, and in all studies, MRD positivity during treatment was associated with worse clinical outcome. MRD positivity was significantly associated with a higher probability of relapse in eleven studies. However, MRD negativity does not exclude the possibility of relapse in pediatric AML, while positivity early during therapy does not exclude cure. <b>Expert opinion</b>: MRD positivity during treatment has emerged as the most powerful prognostic factor in pediatric AML concerning relapse and overall survival and is useful for risk-group adapted treatment. Future studies should identify the optimal time-point(s) for MRD measurements and the optimal technique, to further improve its prognostic significance.

<b>引言</b>：本研究通过系统综述评估了治疗期间可测量残留病（Measurable Residual Disease，MRD）对儿童急性髓系白血病（pediatric acute myeloid leukemia，AML）复发及总生存期的预后价值。<b>综述范围</b>：本研究对现有文献开展系统检索，筛选与儿童AML中MRD作为复发及生存预后因素相关的原创全文文献。最终纳入13项研究，所有研究均显示治疗期间MRD阳性与不良临床结局相关；其中11项研究表明，MRD阳性与更高的复发风险存在显著关联。不过，MRD阴性并不能完全排除儿童AML复发的可能性，而治疗早期MRD阳性也不代表无法治愈。<b>专家观点</b>：目前，治疗期间MRD阳性已被证实是儿童AML中与复发及总生存期相关的最强预后因素，可用于风险分层适配治疗方案。未来研究应明确MRD检测的最佳时间节点与最优技术手段，以进一步提升其预后评估价值。