PDF(Pubmed)
Abstract：
OBJECTIVE: Minimal residual disease (MRD) is a validated prognostic factor in several hematological malignancies. However, its role in systemic light chain (AL) amyloidosis remains controversial, and this systematic review and meta-analysis aims to fill this gap.
METHODS: We searched for relevant studies on Pubmed, Embase, and Cochrane Controlled Register of Trials, nine studies involving 451 patients were included and meta-analyzed. This systematic review has been registered in PROSPERO (CRD42023494169).
RESULTS: Our study found that in the group of patients who achieved very good partial response (VGPR) or better, MRD negativity was correlated with higher cardiac and renal response rates [pooled risk ratio (RR) = 0.74 (95% CI 0.62-0.89), 0.74 (95% CI 0.64-0.87), respectively]. Patients with MRD positivity had a higher hematologic progression rate within two years after MRD detection [pooled RR = 10.31 (95% CI 2.02-52.68)]; and a higher risk of hematologic + organ progression in the first year [pooled RR = 12.57 (95% CI 1.73-91.04)]. Moreover, MRD negativity was correlated with a better progression-free survival (PFS) [pooled hazard ratio (HR) = 0.27 (95% CI 0.17-0.45)]; but it did not significantly improve the overall survival (OS) [pooled HR = 0.34 (95% CI 0.11-1.07)].
CONCLUSIONS: In AL amyloidosis, our study supports that MRD negativity correlates with higher cardiac or renal response rates and indicates a better PFS in the follow-up. However, the correlation between OS and the status of MRD is not significant.
METHODS: We searched for relevant studies on Pubmed, Embase, and Cochrane Controlled Register of Trials, nine studies involving 451 patients were included and meta-analyzed. This systematic review has been registered in PROSPERO (CRD42023494169).
RESULTS: Our study found that in the group of patients who achieved very good partial response (VGPR) or better, MRD negativity was correlated with higher cardiac and renal response rates [pooled risk ratio (RR) = 0.74 (95% CI 0.62-0.89), 0.74 (95% CI 0.64-0.87), respectively]. Patients with MRD positivity had a higher hematologic progression rate within two years after MRD detection [pooled RR = 10.31 (95% CI 2.02-52.68)]; and a higher risk of hematologic + organ progression in the first year [pooled RR = 12.57 (95% CI 1.73-91.04)]. Moreover, MRD negativity was correlated with a better progression-free survival (PFS) [pooled hazard ratio (HR) = 0.27 (95% CI 0.17-0.45)]; but it did not significantly improve the overall survival (OS) [pooled HR = 0.34 (95% CI 0.11-1.07)].
CONCLUSIONS: In AL amyloidosis, our study supports that MRD negativity correlates with higher cardiac or renal response rates and indicates a better PFS in the follow-up. However, the correlation between OS and the status of MRD is not significant.
摘要：
目的：微小残留病（MRD）是几种血液系统恶性肿瘤的有效预后因素。然而,它在系统性轻链（AL）淀粉样变性中的作用仍存在争议，本系统综述和荟萃分析旨在填补这一空白。
方法：我们搜索了有关Pubmed，Embase,和科克伦控制的试验登记册，纳入了9项涉及451例患者的研究,并进行了荟萃分析.该系统评价已在PROSPERO（CRD42023494169）中注册。
结果：我们的研究发现，在达到非常好的部分反应（VGPR）或更好的患者组中，MRD阴性与较高的心脏和肾脏反应率相关[合并风险比（RR）=0.74（95％CI0.62-0.89），0.74（95%CI0.64-0.87），分别]。MRD阳性的患者在MRD检测后两年内的血液学进展率较高[合并RR=10.31(95%CI2.02-52.68)]；第一年血液学+器官进展风险较高[合并RR=12.57(95%CI1.73-91.04)]。此外，MRD阴性与更好的无进展生存期（PFS）[合并风险比（HR）=0.27（95％CI0.17-0.45）]相关；但它并没有显着改善总生存期（OS）[合并HR=0.34（95％CI0.11-1.07）]。
结论：在AL淀粉样变性中，我们的研究支持MRD阴性与较高的心脏或肾脏反应率相关,并提示随访中PFS较好.然而,OS与MRD状态的相关性不显著。
方法：我们搜索了有关Pubmed，Embase,和科克伦控制的试验登记册，纳入了9项涉及451例患者的研究,并进行了荟萃分析.该系统评价已在PROSPERO（CRD42023494169）中注册。
结果：我们的研究发现，在达到非常好的部分反应（VGPR）或更好的患者组中，MRD阴性与较高的心脏和肾脏反应率相关[合并风险比（RR）=0.74（95％CI0.62-0.89），0.74（95%CI0.64-0.87），分别]。MRD阳性的患者在MRD检测后两年内的血液学进展率较高[合并RR=10.31(95%CI2.02-52.68)]；第一年血液学+器官进展风险较高[合并RR=12.57(95%CI1.73-91.04)]。此外，MRD阴性与更好的无进展生存期（PFS）[合并风险比（HR）=0.27（95％CI0.17-0.45）]相关；但它并没有显着改善总生存期（OS）[合并HR=0.34（95％CI0.11-1.07）]。
结论：在AL淀粉样变性中，我们的研究支持MRD阴性与较高的心脏或肾脏反应率相关,并提示随访中PFS较好.然而,OS与MRD状态的相关性不显著。
