A Systematic Review And Meta-analysis Of Minimal Residual Disease With Fcm In Prognosis Of Acute Myeloid Leukemia

Objective: To evaluate the relevance between flow cytometry monitoring the status of minimal residual disease and the prognosis of acute myeloid leukemia during complete remission via evidence-based medicine.With the above conclusions,more specific personalized medicine therapy can be guided in clinical treatment.Method: The databases such as Pubmed,Cochrane library,Embase database,CNKI and WanFang Data base during Jan 1,2015 to Octomber 31,2017 were searched to collect literatures discussing the assessment of MRD wit FCM after complete remission and the influence prognosis in acute myeloid leukemia,besides the references of including articles were also identified.The data was input and analyzed with Cochrane review manager software(Rev Man 5.3 and stata version 12.0 for meta-analysis.Result: There have been a total of 10 studies added up to 2215 patients included in the analysis,which results were as followed.Meta-analysis showed that in adult AML patients,the overall survival and relapse free survival of MRD-positive patients were significantly lower than those of MRD-negative patients.While the relapse rate of MRD-positive patients was significantly higher than those of MRD-negative patients.In the subgroup analysis,three subgroups are named as after induction chemotherapy,after consolidation chemotherapy and before bone marrow transplantation based on the different detecting time points.The result suggests that the heterogeneity of the included searches is evidently reducing implying that the heterogeneity may come from different detecting time points.In another subgroup analysis that categorized MRD thresholds as a classification criterion,the result suggested that the heterogeneity may come from the MRD thresholds.Conclusion: In the adult patients with AML,the rate of overall survival and relapse free survival of the patients with MRD positive group confirming by flow cytometry is lower than MRD negative patients,while the rate of relapse is much higher resulting in a worse prognostic outcome factor.MRD positive status is a poor prognostic factor in different detecting point and different MRD thresholds.