Blood:分子分类可改善BCR-ABL1阴性B-ALL成人患者的风险评估

2021-09-24 xiaozeng MedSci原创

分子分类可改善BCR-ABL1阴性B-ALL成人患者的风险评估

中心点:基因检测可改善大多数BCR-ABL1-B-ALL成年患者的风险分配;结合基因亚型考虑时,抗原谱可影响B-ALL患者的结局。

基因组分类改善了B系急性淋巴细胞白血病(B-ALL)儿童患者的风险分配,但对B-ALL成人患者的无优化作用。国际性UKALLXII/ECOG-ACRIN E2993 (#NCT00002514) 试验累计招募了1229位BCR-ABL1-B-ALL青少年/成人患者(14-65岁)。在该试验中,尽管93%的患者可获得缓解,但41%的患者在中位时间为13个月(范围:28天至12年)时复发。5年总存活率(OS)为42%(95% CI 39-44)。

不同分子亚组的抗原表达

通过转录组测序、基因表达谱、细胞遗传学和融合聚合酶链反应,对282位患者的样本进行了基因组分型,其中264例符合试验条件,占E2993试验患者的64.5%。

在有结果信息的患者中,29.5%的结果良好(5年OS:65%-80%)的患者被认为是标准风险(DUX4重排:9.2%;ETV6-RUNX1/-样:2.3%;TCF3-PBX1:6.9%;PAX5 P80R:4.1%;高超二倍体:6.9%)50.2%的患者为高危亚型,5年OS为0%-27%(Ph样:21.2%;KMT2A-AFF1:12%;低亚二倍体/近单倍体:14.3%;BCL2/MYC重排:2.8%);20.3%的患者为中危亚型,5年OS为33%-45%(PAX5alt:12.4%;ZNF384/-样:5.1%;MEF2D重排:2.8%)。

不同分子亚组的患者的RFS和OS

86%的Ph样突变患者存在IKZF1变异,54%的低亚二倍体患者和33%的BCL2/MYC重排患者存在TP53变异;IKZF1和TP53变异与预后均无独立相关性。

在根据年龄和白细胞计数评估的高风险患者中,40%的患者存在与标准或中等风险结果相关的亚型定义基因改变。此外,研究人员还确定了DUX4重排、PAX5 P80R、ZNF384-R/-样和 Ph-样基因型的不同免疫表型特征

总之,该研究显示了基因组分析的预后重要意义,这可能会转化为未来的治疗益处

原始出处:

Elisabeth Paietta, et al. Molecular classification improves risk assessment in adult BCR-ABL1–negative B-ALL. Blood (2021) 138 (11): 948–958.

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    2022-04-26 denglimoxiaoran

    学习

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    2021-09-26 膀胱癌
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  6. [GetPortalCommentsPageByObjectIdResponse(id=1956484, encodeId=882719564845c, content=<a href='/topic/show?id=002d32834b' target=_blank style='color:#2F92EE;'>#BCR-ABL1#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=38, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=3283, encryptionId=002d32834b, topicName=BCR-ABL1)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=951d2500061, createdName=12498717m66(暂无昵称), createdTime=Tue Nov 16 07:47:41 CST 2021, time=2021-11-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2027660, encodeId=7788202e660b1, content=<a href='/topic/show?id=68f6315e6a4' target=_blank style='color:#2F92EE;'>#分子分类#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=20, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=31576, encryptionId=68f6315e6a4, topicName=分子分类)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=6595338, createdName=xuruicheng, createdTime=Fri Apr 29 20:47:41 CST 2022, time=2022-04-29, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1214401, encodeId=857f1214401b3, content=学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=23, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f4f22999147, createdName=denglimoxiaoran, createdTime=Tue Apr 26 09:07:46 CST 2022, time=2022-04-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1329555, encodeId=a459132955549, content=<a href='/topic/show?id=bb96232801' target=_blank style='color:#2F92EE;'>#ALL#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=23, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=2328, encryptionId=bb96232801, topicName=ALL)], attachment=null, authenticateStatus=null, createdAvatar=http://thirdqq.qlogo.cn/qqapp/1103841572/C2EFD5CFB07FE291138AD4FD0C98E3DE/100, createdBy=e3d52500031, createdName=膀胱癌, createdTime=Sun Sep 26 12:47:41 CST 2021, time=2021-09-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1423262, encodeId=206114232625c, content=<a href='/topic/show?id=18f43131be' target=_blank style='color:#2F92EE;'>#B-ALL#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=26, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=3131, encryptionId=18f43131be, topicName=B-ALL)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=7c123763345, createdName=chenzhuanggui, createdTime=Sun Sep 26 12:47:41 CST 2021, time=2021-09-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1054621, encodeId=d88910546218d, content=了解一下, beContent=null, objectType=article, channel=null, level=null, likeNumber=37, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=b7a31928393, createdName=学医无涯, createdTime=Sat Sep 25 07:37:10 CST 2021, time=2021-09-25, status=1, ipAttribution=)]
    2021-09-25 学医无涯

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