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Inicio Medicina Clínica (English Edition) Minimal residual disease in chronic lymphocytic leukaemia
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Vol. 150. Issue 4.
Pages 144-149 (February 2018)
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Vol. 150. Issue 4.
Pages 144-149 (February 2018)
Review
Minimal residual disease in chronic lymphocytic leukaemia
Enfermedad mínima residual en la leucemia linfocítica crónica
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6
José Antonio García Velaa,
Corresponding author
, José Antonio García Marcob
a Laboratorio de Citometría de Flujo, Servicio de Hematología y Hemoterapia, Hospital Universitario de Getafe, Getafe, Madrid, Spain
b Laboratorio de Genética Molecular, Servicio de Hematología y Hemoterapia, Hospital Universitario Puerta de Hierro, Madrid, Spain
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Tables (3)
Table 1. Treatment criteria.
Table 2. Characteristics of the two minimal residual disease detection methods most used in clinical trials.
Table 3. Samples to be analyzed in the minimal residual disease study.
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Abstract

Minimal residual disease (MRD) assessment is an important endpoint in the treatment of chronic lymphocytic leukaemia (CLL). It is highly predictive of prolonged progression-free survival (PFS) and overall survival and could be considered a surrogate for PFS in the context of chemoimmunotherapy-based treatment. Evaluation of MRD level by flow cytometry or molecular techniques in the era of the new BCR and Bcl-2 targeted inhibitors could identify the most cost-effective and durable treatment sequencing. A therapeutic approach guided by the level of MRD might also determine which patients would benefit from an early stop or consolidation therapy. In this review, we discuss the different MRD methods of analysis, which source of tumour samples must be analyzed, the future role of the detection of circulating tumour DNA, and the potential role of MRD negativity in clinical practice in the modern era of CLL therapy.

Keywords:
Chronic lymphocytic leukaemia
Flow cytometry
Ibrutinib
Idelalisib
Venetoclax
Obinutuzumab
Minimal residual disease
Resumen

La evaluación de la enfermedad mínima residual (EMR) es un objetivo importante en el tratamiento de la leucemia linfocítica crónica (LLC). Su obtención es predictiva de una supervivencia libre de progresión (SLP) y una supervivencia global prolongadas y podría considerarse una variable subrogada de la SLP en el contexto del tratamiento con quimioinmunoterapia. La evaluación de la EMR mediante citometría de flujo o técnicas moleculares en la era de los nuevos inhibidores de BCR o Bcl-2 podría identificar la secuencia de tratamiento más coste-efectiva y la duración de la misma. Una aproximación terapéutica guiada por el nivel de EMR también podría determinar qué pacientes se beneficiarían de un tratamiento de consolidación o de una finalización precoz del mismo. En esta revisión discutimos los diferentes métodos de análisis de la EMR, qué muestras deben ser analizadas, el papel futuro de la detección del ADN tumoral circulante y el papel potencial de la negatividad de la EMR en la práctica clínica en la era moderna del tratamiento de la LLC.

Palabras clave:
Leucemia linfocítica crónica
Citometría de flujo
Ibrutinib
Idelalisib
Venetoclax
Obinutuzumab
Enfermedad mínima residual

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