Blood:急性淋巴细胞白血病的风险分层适应性疗法

2020-07-16 医刀 MedSci原创

风险分层和早期大剂量阿糖胞苷强化治疗可改善KMT2A-重排型ALL患婴的EFS;早期MRD清除是ALL患婴良好预后的一个重要预测指标

患有急性淋巴细胞白血病(ALL)的婴儿,特别是携带KMT2A基因重排(KMT2A-r)的婴儿,预后很差。日本一直在努力研究干细胞移植(HSCT)在携带KMT2A-r的ALL患婴中的作用,但预后改善效果差强人意。

在日本儿科白血病/淋巴瘤研究组试验MLL-10中,根据KMT2A状态、年龄和有无中枢神经系统白血病将ALL患婴分成三个风险组:低风险(LR)、中风险(IR)和高风险(HR)组。

予以KMT2A-r患婴改良的儿童肿瘤学AALL0631化疗方案,并在早期强化治疗中加入大剂量阿糖胞苷,另外HSCT仅限于HR患者。同时还评估了微小残留病灶的作用。

共招募了90位符合要求的婴儿,LR组有15位、IR组有19位、HR组有56位。KMT2A-r型ALL(IR+HR)患者的三年无事件存活(EFS)率为66.2%,KMT2A-g型ALL(LR)患者的三年EFS率为93.3%。IR患者和HR患者的三年EFS率分别是94.4%和56.6%。

在多变量分析中,女性和早期巩固治疗结束时MRD≥0.01%都是预后明显不良的因素。

综上所述,本研究中的风险分层和强化化疗的引入是有效的,能够代替部分KMT2A-r型ALL婴儿的HSCT。早早清除MRD可改善预后,此外,应在以后的试验中纳入风险分层。

原始出处:

Daisuke Tomizawa,et al. A risk-stratified therapy for infants with acute lymphoblastic leukemia: a report from the JPLSG MLL-10 trial. Blood. July 07,2020.

版权声明:
本网站所有内容来源注明为“梅斯医学”或“MedSci原创”的文字、图片和音视频资料,版权均属于梅斯医学所有。非经授权,任何媒体、网站或个人不得转载,授权转载时须注明来源为“梅斯医学”。其它来源的文章系转载文章,或“梅斯号”自媒体发布的文章,仅系出于传递更多信息之目的,本站仅负责审核内容合规,其内容不代表本站立场,本站不负责内容的准确性和版权。如果存在侵权、或不希望被转载的媒体或个人可与我们联系,我们将立即进行删除处理。
在此留言
评论区 (4)
#插入话题
  1. [GetPortalCommentsPageByObjectIdResponse(id=1997987, encodeId=ae19199e98746, content=<a href='/topic/show?id=75ff66001cd' target=_blank style='color:#2F92EE;'>#淋巴细胞白血病#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=20, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=66001, encryptionId=75ff66001cd, topicName=淋巴细胞白血病)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=1be8234, createdName=sunyl07, createdTime=Wed Sep 23 15:27:39 CST 2020, time=2020-09-23, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1302327, encodeId=855a130232e1f, content=<a href='/topic/show?id=82a6659902c' target=_blank style='color:#2F92EE;'>#淋巴细胞#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=27, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=65990, encryptionId=82a6659902c, topicName=淋巴细胞)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=1e34303, createdName=wetgdt, createdTime=Sat Jul 18 11:27:39 CST 2020, time=2020-07-18, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1360976, encodeId=b13413609e636, content=<a href='/topic/show?id=e372100861dc' target=_blank style='color:#2F92EE;'>#风险分层#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=31, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=100861, encryptionId=e372100861dc, topicName=风险分层)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=4fd6156, createdName=oliver169, createdTime=Sat Jul 18 11:27:39 CST 2020, time=2020-07-18, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1621038, encodeId=2f531621038de, content=<a href='/topic/show?id=dccc94e01c9' target=_blank style='color:#2F92EE;'>#适应性#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=27, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=94701, encryptionId=dccc94e01c9, topicName=适应性)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=b13a20191510, createdName=huhuaidong394, createdTime=Sat Jul 18 11:27:39 CST 2020, time=2020-07-18, status=1, ipAttribution=)]
  2. [GetPortalCommentsPageByObjectIdResponse(id=1997987, encodeId=ae19199e98746, content=<a href='/topic/show?id=75ff66001cd' target=_blank style='color:#2F92EE;'>#淋巴细胞白血病#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=20, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=66001, encryptionId=75ff66001cd, topicName=淋巴细胞白血病)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=1be8234, createdName=sunyl07, createdTime=Wed Sep 23 15:27:39 CST 2020, time=2020-09-23, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1302327, encodeId=855a130232e1f, content=<a href='/topic/show?id=82a6659902c' target=_blank style='color:#2F92EE;'>#淋巴细胞#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=27, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=65990, encryptionId=82a6659902c, topicName=淋巴细胞)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=1e34303, createdName=wetgdt, createdTime=Sat Jul 18 11:27:39 CST 2020, time=2020-07-18, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1360976, encodeId=b13413609e636, content=<a href='/topic/show?id=e372100861dc' target=_blank style='color:#2F92EE;'>#风险分层#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=31, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=100861, encryptionId=e372100861dc, topicName=风险分层)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=4fd6156, createdName=oliver169, createdTime=Sat Jul 18 11:27:39 CST 2020, time=2020-07-18, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1621038, encodeId=2f531621038de, content=<a href='/topic/show?id=dccc94e01c9' target=_blank style='color:#2F92EE;'>#适应性#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=27, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=94701, encryptionId=dccc94e01c9, topicName=适应性)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=b13a20191510, createdName=huhuaidong394, createdTime=Sat Jul 18 11:27:39 CST 2020, time=2020-07-18, status=1, ipAttribution=)]
  3. [GetPortalCommentsPageByObjectIdResponse(id=1997987, encodeId=ae19199e98746, content=<a href='/topic/show?id=75ff66001cd' target=_blank style='color:#2F92EE;'>#淋巴细胞白血病#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=20, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=66001, encryptionId=75ff66001cd, topicName=淋巴细胞白血病)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=1be8234, createdName=sunyl07, createdTime=Wed Sep 23 15:27:39 CST 2020, time=2020-09-23, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1302327, encodeId=855a130232e1f, content=<a href='/topic/show?id=82a6659902c' target=_blank style='color:#2F92EE;'>#淋巴细胞#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=27, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=65990, encryptionId=82a6659902c, topicName=淋巴细胞)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=1e34303, createdName=wetgdt, createdTime=Sat Jul 18 11:27:39 CST 2020, time=2020-07-18, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1360976, encodeId=b13413609e636, content=<a href='/topic/show?id=e372100861dc' target=_blank style='color:#2F92EE;'>#风险分层#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=31, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=100861, encryptionId=e372100861dc, topicName=风险分层)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=4fd6156, createdName=oliver169, createdTime=Sat Jul 18 11:27:39 CST 2020, time=2020-07-18, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1621038, encodeId=2f531621038de, content=<a href='/topic/show?id=dccc94e01c9' target=_blank style='color:#2F92EE;'>#适应性#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=27, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=94701, encryptionId=dccc94e01c9, topicName=适应性)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=b13a20191510, createdName=huhuaidong394, createdTime=Sat Jul 18 11:27:39 CST 2020, time=2020-07-18, status=1, ipAttribution=)]
  4. [GetPortalCommentsPageByObjectIdResponse(id=1997987, encodeId=ae19199e98746, content=<a href='/topic/show?id=75ff66001cd' target=_blank style='color:#2F92EE;'>#淋巴细胞白血病#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=20, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=66001, encryptionId=75ff66001cd, topicName=淋巴细胞白血病)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=1be8234, createdName=sunyl07, createdTime=Wed Sep 23 15:27:39 CST 2020, time=2020-09-23, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1302327, encodeId=855a130232e1f, content=<a href='/topic/show?id=82a6659902c' target=_blank style='color:#2F92EE;'>#淋巴细胞#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=27, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=65990, encryptionId=82a6659902c, topicName=淋巴细胞)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=1e34303, createdName=wetgdt, createdTime=Sat Jul 18 11:27:39 CST 2020, time=2020-07-18, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1360976, encodeId=b13413609e636, content=<a href='/topic/show?id=e372100861dc' target=_blank style='color:#2F92EE;'>#风险分层#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=31, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=100861, encryptionId=e372100861dc, topicName=风险分层)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=4fd6156, createdName=oliver169, createdTime=Sat Jul 18 11:27:39 CST 2020, time=2020-07-18, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1621038, encodeId=2f531621038de, content=<a href='/topic/show?id=dccc94e01c9' target=_blank style='color:#2F92EE;'>#适应性#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=27, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=94701, encryptionId=dccc94e01c9, topicName=适应性)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=b13a20191510, createdName=huhuaidong394, createdTime=Sat Jul 18 11:27:39 CST 2020, time=2020-07-18, status=1, ipAttribution=)]

相关资讯

JACC:多标记物方法识别SAVR术后死亡率和再住院率高的主动脉瓣狭窄患者

外科AVR治疗的严重AS患者中,心血管应激生物标志物升高数量的增多与全因、心血管死亡率升高和再住院率高相关。

Clin Chem:血液中游离SHOX2 DNA甲基化作为肾细胞癌风险分层的分子分期参数

现如今,新的靶向治疗和免疫疗法已经极大地改善了晚期和转移性肾细胞癌 · 2019-07-20

-->

Arthritis Rheumatol:血浆血管生物标志物在系统性硬化症中的有效性

这些数据表明,参与血管生成的分子反映了血管的扰动,入组时生物标志物的升高可以对患者进行危险分层。

Blood:一种新的儿童急性淋巴细胞白血病风险分层方法

风险分层对选择儿童急性淋巴细胞白血病的最佳治疗至关重要。但目前的风险分层算法对变量进行二分法处理,并独立应用风险因素,这可能会错误地假设生物多样性子集之间存在相同的关联,从而降低统计能力。因此,Enshaei等人开发并验证了一种综合多种危险因素并使用连续数据的预后指数(PIUKALL)。研究人员将近期的4个试验(UKALL2003、COALL-03、DCOG-ALL10和NOPHO-ALL2008

Eur Heart J:基于机器学习的心脏再同步治疗患者的死亡率预测

SEMMELWEIS-CRT评分(可在semmelweiscrtscore.com上获得)显示出良好的判别力,可以预测CRT患者的全因死亡率,并且优于现有的风险评分。

J Clin Oncol:Canary前列腺积极监测研究(PASS)群体中的17个基因基因组前列腺评分测试结果

17-gene Oncotype DX Genomic Prostate Score(GPS)测试能够预测立即进行手术的低风险前列腺癌患者的不良病理(AP)。最近,有研究人员在一个多中心积极监测群体中