Identification Of Individualized Minimal Residual Disease In Acute Myeloid Leukemia By Flow Cytometry And Its Prognostic Significance

Acute myeloid leukemia(AML)is a kind of hematology malignancies with high heterogeneity.The clinical characteristics and prognosis of the patients are quite different.Based on the leukemia-associated immunophenotypes(LAIP)of AML,the minimal residual disease(MRD)which is related with the outcome of the patients after treatment could be detected by multiparameter flow cytometry.However,the precise threshold of MRD for prognosis prediction in AML still remains controversial.In this study,we defined the background levels of 36 kinds of LAIP that dectected in292 AML patients by flow cytometry.According to the expression level in normal or regenerating bone marrow,the individualized MRD cut off value of each kind of LAIP was established.The prognostic analysis showed that,comparing with the standard MRD cut off value of 0.1%,individual-MRD distinguished the patients with different outcome more precisely.Notebly,in patients of low or intermediate risk groups according to the NCCN risk stratification,the Individual-MRD threshold could identify the patients with significantly different outcome.With combination of Individual-MRD,karyotype and gene mutation characteristics,we proposed a revised risk stratification model.For the favorable risk group of the new model,bone marrow transplantation might be unnecessary.In conclusion,Individual-MRD statuses could improve the cytogenetic-molecular risk stratification system and contribute to the clinical decision-making.