• Sacha Greene posted an update 1 week, 2 days ago

    Le disease in peripheral blood or bone marrow even when pretty sensitive immunophenotypic or molecular solutions are applied to look for residual disease. These individuals are regarded as to have accomplished a minimal residual disease (MRD) damaging status.17-20 Several phase II trials have demonstrated that patients reaching MRD negativity have a signif-icantly longer 8,22 Sadly, none of these therapeutic survival than individuals who remain MRD constructive, and this really is accurate for patients treated with standard chemotherapy,21,22 monoclonal antibodies,23 chemoimmunotherapy,24 or stem cell transplantation.25,26 In addition, a phase III trial performed by the German CLL Study Group (GCLLSG) not too long ago revealed that sufferers obtaining MRD negativity had significantly longer progression-free and overall survivals, irrespectively from the treatment received.18 However, having said that, a few of these research were flawed by inappropriate statistical evaluation, particularly the measurement of time-to-event outcomes from treatment initiation.27 Furthermore, there are several caveats towards the use of MRD analysis in sufferers with CLL.28 Very first, CLL remains incurable and a minimum of 30 of patients who obtain MRD negativity following front-line therapy with fludarabine-cyclophosphamide (FC) or rituximab-FC eventually expertise a illness relapse within 5 years.18 Secondly, unlike the predicament in acute promyelocytic leukemia or chronic myeloid leukemia,29,30 there is no formal proof of a therapeutic advantage of re-treatment upon documentation of MRD positivity just after an initial MRD-negative response compared to remedy at the time of clinical relapse. In actual fact, very couple of studies have demonstrated a clear benefit from MRD eradication or consolidation therapy in CLL,31,32 and some in the techniques tested, while efficient, resulted in considerable toxicity.33-35 Thirdly, it may very well be argued that MRD assessment is basically a surrogate for evalution of other adverse prognostic markers since, for instance, individuals using a 17p014 Ferrata Storti Foundation. That is an open-access paper. doi:ten.3324/haematol.2013.099796 The on-line version of this article features a Supplementary Appendix. Manuscript received on October 17, 2013. Manuscript accepted on December 31, 2013. Correspondence: jdelgado@clinic.ub.eshaematologica | 2014; 99(five)R. Santacruz et al.deletion have a larger probability of remaining MRD-positive after therapy when compared with sufferers without having this chromosome abnormality.18 For all these causes, present recommendations for the management of individuals with CLL suggest MRD assessment only within clinical trials with “curative intention”.36 With all this facts in thoughts, we retrospectively evaluated the impact of MRD on the outcome of individuals with CLL getting any front-line therapy within the context of a really detailed prognostic evaluation, like recently described recurrent gene mutations.survival and overall survival have been calculated making use of a landmark analysis. All calculations have been performed making use of either SPSS, version 18.0, or R, version 3.0.1. Two-sided P values 0.05 have been thought of statistically substantial. A detailed explanation on the statistical strategies is available within the Online Supplement.Results Baseline characteristicsThe median age on the entire cohort was 58 years (variety, 27-93 years), and also the percentage of individuals older than 70 years was 22 . As outlined by D ner’s hierarchical model, 17/221 (8 ) and 40/221 (18 ) individuals had 17p deletion and 11q deletion, respectively.