الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
Acute myeloid leukemia is a heterogeneous disease characterized by diverse genetic abnormalities and variable morphology, immunophenotypes, and clinical outcomes. It is the commonest type of leukemia in adults, accounting for 25% of all leukemia types.
Relapse remains the main cause of treatment failure and death in AML. Although more than 80% of patients achieve complete remission after conventional chemotherapy, a significant number of them experience recurrence of disease.
Response to treatment is one of the few post-diagnosis prognostic factors. Despite risk stratification, patients often perform differently than predicted, for instance, there are good risk patients who relapse and poor risk patients who are cured. As this can translate into under- treatment and over-treatment, respectively, there is a definite need for additional prognostic markers to refine current risk stratification, ultimately resulting in more personalized treatment, with consequent improvement of overall survival (OS).
MRD thus offers a sensitive method to predict clinical outcome, currently, MRD frequency is determined to improve risk stratification, monitor therapy response and guide therapy. MRD was found to be a factor with independent prognostic impact, both after induction therapy and consolidation therapy, independent of the type of consolidation therapy.
Flow cytometry and molecular techniques for assessment of MRD are more sensitive than morphologic assessment, and consensus is growing that MRD might be better called “measurable residual disease,” because the presence of any disease detected by these methodologies after treatment is associated with a worse prognosis and detection of residual disease even in morphologic remission may not be “minimal”. Molecular-based MRD is assessed by RT- qPCR and newer technologies, including NGS are promising, but do not replace MFC-MRD.
MRD can be assessed by MFC using three different approaches; LAIPs approach, DfN approach and LSCs approach using single LSCs tube. The ELN MRD Working Party recommended to combine both approaches to best define MFC MRD burden and suggested the term “LAIP-based DfN approach” for this combined strategy, thus allowing detection of new aberrancies emerging at follow-up, and monitoring patients in absence of diagnostic information in addition to the use of single LSC panel in which the total LSCs load can be assessed at any time from diagnosis to relapse.