التفاصيل البيبلوغرافية
| العنوان: |
[Multicenter evaluation of minimal residual disease monitoring in early induction therapy for treatment of childhood acute lymphoblastic leukemia]. |
| المؤلفون: |
Wu XJ; Department of Hematology and Oncology, Children's Medical Center, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510120, China., Liao N; Department of Pediatrics, the First Affiliated Hospital of Guangxi Medical University, Nanning 530021, China., Mai HR; Department of Hematology and Oncology, Shenzhen Children's Hospital, Shenzhen 518026, China., Li XY; Department of Hematology and Oncology, Children's Medical Center, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510120, China., Wan WQ; Department of Pediatrics, the Second Xiangya Hospital of Central South University, Changsha 410011, China., Yang LH; Department of Pediatric Hematology, Zhujiang Hospital, Southern Medical University, Guangzhou 510280, China., Huang LB; Department of Pediatrics, the First Affiliated Hospital, Sun Yat-sen University, Guangzhou 510062, China., Luo XQ; Department of Pediatrics, the Third Affiliated Hospital, Sun Yat-sen University, Guangzhou 510630, China., Tian C; Department of Pediatrics, Affiliated Hospital of Guangdong Medical University, Zhanjiang 524002, China., Chen QW; Department of Pediatrics, the First Affiliated Hospital of Nanchang University, Nanchang 330006, China., Long XJ; Department of Pediatrics, Liuzhou People's Hospital, Liuzhou 545006, China., He YY; Department of Pediatrics, the First Affiliated Hospital of Guangxi Medical University, Nanning 530021, China., Wang Y; Department of Hematology and Oncology, Shenzhen Children's Hospital, Shenzhen 518026, China., Li ZG; Department of Pediatrics, Prince of Wales Hospital, Hong Kong 999077, China., Xu HG; Department of Hematology and Oncology, Children's Medical Center, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510120, China. |
| المصدر: |
Zhonghua er ke za zhi = Chinese journal of pediatrics [Zhonghua Er Ke Za Zhi] 2024 Mar 25; Vol. 62 (4), pp. 337-344. |
| نوع المنشور: |
Multicenter Study; English Abstract; Journal Article |
| اللغة: |
Chinese |
| بيانات الدورية: |
Publisher: Chinese Medical Association Country of Publication: China NLM ID: 0417427 Publication Model: Print Cited Medium: Print ISSN: 0578-1310 (Print) Linking ISSN: 05781310 NLM ISO Abbreviation: Zhonghua Er Ke Za Zhi Subsets: MEDLINE |
| أسماء مطبوعة: |
Original Publication: Beijing : Chinese Medical Association, 1950 |
| مواضيع طبية MeSH: |
Induction Chemotherapy* , Precursor Cell Lymphoblastic Leukemia-Lymphoma*/diagnosis , Precursor Cell Lymphoblastic Leukemia-Lymphoma*/drug therapy, Child ; Female ; Humans ; Male ; Disease-Free Survival ; Neoplasm, Residual/diagnosis ; Prognosis ; Recurrence ; Retrospective Studies ; Infant ; Child, Preschool ; Adolescent |
| مستخلص: |
Objective: To evaluate the role of minimal residual disease (MRD) monitoring during early induction therapy for the treatment of childhood acute lymphoblastic leukemia (ALL). Methods: This was a multicenter retrospective cohort study. Clinical data of 1 164 ALL patients first diagnosed between October 2016 and June 2019 was collected from 16 hospitals in South China Children's Leukemia Group. According to MRD assay on day 15 of early induction therapy, they were divided into MRD<0.10% group, MRD 0.10%-<10.00% group and MRD≥10.00% group. According to MRD assay on day 33, they were divided into MRD<0.01% group, MRD 0.01%-<1.00% group and MRD≥1.00% group. Age, onset white blood cell count, central nervous system leukemia (CNSL), molecular genetic characteristics and other data were compared between groups. Kaplan-Meier method was used for survival analysis. Cox regression model was used to analyze prognostic factors. Results: Of the 1 164 enrolled patients, there were 692 males and 472 females. The age of diagnosis was 4.7 (0.5, 17.4) years. The white blood cell count at initial diagnosis was 10.7 (0.4, 1 409.0) ×10 9 /L. Among all patients, 53 cases (4.6%) had CNSL. The follow-up time was 47.6 (0.5, 68.8) months. The 5-year overall survival (OS) and 5-year relapse-free survival (RFS) rates were (93.1±0.8) % and (90.3±1.1) %. On day 15 of early induction therapy, there were 466 cases in the MRD<0.10% group, 523 cases in the MRD 0.10%-<10.00% group and 175 cases in the MRD≥10.00% group. The 5-year OS rates of the MRD<0.10% group, MRD 0.10%-<10.00% group and MRD≥10.00% group were (95.4±1.0) %, (93.3±1.1) %, (85.4±2.9) %, respectively, while the RFS rates were (93.2±1.6) %, (90.8±1.4) %, (78.9±4.3) %, respectively ( χ 2 =16.47, 21.06, both P <0.05). On day 33 of early induction therapy, there were 925 cases in the MRD <0.01% group, 164 cases in the MRD 0.01%-<1.00% group and 59 cases in the MRD≥1.00% group. The 5-year RFS rates in the MRD 0.01%-<1.00% group was lowest among three groups ((91.4±1.2) % vs. (84.5±3.2) % vs. (87.9±5.1) %). The difference between three groups is statistically significant ( χ 2 =9.11, P =0.010). Among ALL patients with MRD≥10.00% on day 15 of induction therapy, there were 80 cases in the MRD <0.01% group on day 33, 45 cases in the MRD 0.01%-<1.00% group on day 33 and 45 cases in the MRD≥1.00% group on day 33. The 5-year RFS rates of three groups were (83.9±6.0)%, (67.1±8.2)%, (83.3±6.9)% respectively ( χ 2 =6.90, P =0.032). Univariate analysis was performed in the MRD≥10.00% group on day 15 and the MRD 0.01%-<1.00% group on day 33.The 5-year RFS rate of children with CNSL was significantly lower than that without CNSL in the MRD≥10.00% group on day 15 ((50.0±20.4)% vs. (80.3±4.4)%, χ 2 =4.13, P =0.042). Patients with CNSL or MLL gene rearrangement in the MRD 0.01%-<1.00% group on day 33 had significant lower 5-year RFS rate compared to those without CNSL or MLL gene rearrangement ((50.0±25.0)% vs. (85.5±3.1)%, χ 2 =4.06, P =0.044;(58.3±18.6)% vs. (85.7±3.2)%, χ 2 =9.44, P =0.002). Multivariate analysis showed that age ( OR =0.58, 95% CI 0.35-0.97) and white blood cell count at first diagnosis ( OR =0.43, 95% CI 0.27-0.70) were independent risk factors for OS. The MRD level on day 15 ( OR =0.55,95% CI 0.31-0.97), ETV6-RUNX1 fusion gene ( OR =0.13,95% CI 0.03-0.54), MLL gene rearrangement ( OR =2.55,95% CI 1.18-5.53) and white blood cell count at initial diagnosis ( OR =0.52,95% CI 0.33-0.81) were independent prognostic factors for RFS. Conclusions: The higher the level of MRD in early induction therapy, the worse the OS. The MRD levels on day 15 is an independent prognostic factor for RFS.The MRD in early induction therapy guided accurate risk stratification and individualized treatment can improve the survival rate of pediatric ALL. |
| معلومات مُعتمدة: |
2007016 Clinical Medical Research 5010 Foundation of Sun Yat-sen University |
| فهرسة مساهمة: |
Local Abstract: [Publisher, Chinese] 目的： 探讨诱导治疗早期微小残留病（MRD）监测对儿童急性淋巴细胞白血病（ALL）治疗的价值。 方法： 多中心回顾性队列研究。分析2016年10月至2019年6月华南儿童急性淋巴细胞白血病协作组的16家医院治疗的1 164例初诊ALL患儿临床资料。根据诱导治疗第15天 MRD 水平分为MRD<0.10%组、MRD 0.10%~<10.00%组、MRD≥10.00%组；根据诱导治疗第33天MRD水平分为MRD<0.01%组、MRD 0.01%~<1.00%组、MRD≥1.00%组。分析各组间年龄、初诊白细胞计数、有无中枢神经系统白血病（CNSL）、分子遗传学特征等差异，应用Kaplan-Meier法进行生存分析，Cox回归模型进行预后相关因素分析。 结果： 1 164例ALL患儿中男692例、女472例，诊断年龄4.7（0.5，17.4）岁，初诊白细胞计数10.7（0.4，1 409.0）×10 9 /L，53例（4.6%）有CNSL，随访时间47.6（0.5，68.8）个月。5年总生存率（OS）为（93.1±0.8）%，无复发生存率（RFS）为（90.3±1.1）%。诱导治疗第15天MRD<0.10%组466例，MRD 0.10%~<10.00%组523例，MRD≥10.00%组175例，5年OS分别为（95.4±1.0）%、（93.3±1.1）%、（85.4±2.9）%，三组间比较差异有统计学意义（ χ 2 =16.47， P <0.05）；5年RFS分别为（93.2±1.6）%、（90.8±1.4）%、（78.9±4.3）%，三组间比较差异有统计学意义（ χ 2 =21.06， P <0.05）。诱导治疗第33天MRD<0.01%组925例，MRD 0.01%~<1.00%组164例，MRD≥1.00%组59例，5年RFS分别为（91.4±1.2）% 、 （84.5±3.2）% 、 （87.9±5.1）%，三组间比较差异有统计学意义（ χ 2 =9.11， P =0.010）。诱导治疗第15天MRD≥10.00%的ALL患儿中，第33 天MRD<0.01%组80例，第33天MRD 0.01%~<1.00%组45例，第33 天MRD≥1.00%组45例，5年RFS分别为（83.9±6.0）%、（67.1±8.2）%、（83.3±6.9）%，三组间比较差异有统计学意义（ χ 2 =6.90， P =0.032）。对诱导治疗第15天MRD≥10.00%组、第33天MRD 0.01%~<1.00%组单因素分析显示，第15天MRD≥10.00%组伴有CNSL患儿5年RFS明显低于不伴CNSL患儿［（50.0±20.4）% 比（80.3±4.4）%， χ 2 =4.13， P =0.042］。第33天MRD 0.01%~<1.00%组伴有CNSL或MLL基因重排患儿5年RFS明显低于不伴CNSL或MLL基因重排患儿［（50.0±25.0）%比（85.5±3.1）%， χ 2 =4.06， P =0.044；（58.3±18.6）% 比（85.7±3.2）%， χ 2 =9.44， P =0.002］。多因素分析显示年龄（ OR =0.58，95% CI 0.35~0.97）、初诊白细胞计数（ OR =0.43，95% CI 0.27~0.70）是OS的独立影响因素。诱导治疗第15天MRD（ OR =0.55，95% CI 0.31~0.97）、ETV6-RUNX1融合基因（ OR =0.13，95% CI 0.03~0.54）、MLL基因重排（ OR =2.55，95% CI 1.18~5.53）、初诊白细胞计数（ OR =0.52，95% CI 0.33~0.81）是RFS的独立影响因素。 结论： 诱导治疗早期MRD水平越高，OS越差。第15天MRD水平是RFS独立影响因素。应用诱导治疗早期MRD水平指导危险度分型进行个体化治疗有望提高ALL患儿长期生存率。. |
| تواريخ الأحداث: |
Date Created: 20240325 Date Completed: 20240327 Latest Revision: 20240403 |
| رمز التحديث: |
20240403 |
| DOI: |
10.3760/cma.j.cn112140-20230729-00046 |
| PMID: |
38527504 |
| قاعدة البيانات: |
MEDLINE |
