文章：

18-65岁急性淋巴细胞白血病的更新风险导向策略：NILG ALL 10/07

Updated risk-oriented strategy for acute lymphoblastic leukemia in adult patients 18–65 years: NILG ALL 10/07

原文发布日期：2020-11-13

DOI: 10.1038/s41408-020-00383-2

类型: Article

开放获取: 是

英文摘要：

An updated strategy combining pediatric-based chemotherapy with risk-oriented allogeneic hematopoietic cell transplantation (HCT) was evaluated in Philadelphia chromosome-negative acute lymphoblastic leukemia (Ph− ALL) and compared with a published control series. Following induction–consolidation chemotherapy, responsive patients were assigned to receive maintenance chemotherapy or undergo early HCT according to the risk stratification criteria and minimal residual disease (MRD) status. Of the 203 study patients (median age 41 years, range 17–67), 140/161 with Ph− ALL achieved complete remission (86.9%; 91.6% ≤55 years, P = 0.0002), with complete MRD clearing in 68/109; 55 patients were assigned to maintenance chemotherapy, and 85 to HCT due to very high-risk characteristics (hyperleukocytosis, adverse genetics, early/mature T-precursor ALL, and MRD persistence). The 5-year relapse incidence was 36%, and the treatment-related mortality rate was 18%. Median overall and relapse-free survival were 7.4 and 6.2 years, with rates of 54 and 53% at 5 years, respectively, which were significantly better than those obtained with the historical protocol (P = 0.001 and P = 0.005, respectively), without significant differences between maintenance and HCT cohorts. In prognostic analysis, MRD negativity and age ≤55 years were the most favorable independent prognostic factors. A reduction in treatment toxicity and further improvements in the risk definitions and risk-oriented design are the focuses of this ongoing research.
 

摘要翻译： 

一项结合儿科化疗方案与风险导向异基因造血细胞移植（HCT）的更新策略在费城染色体阴性急性淋巴细胞白血病（Ph− ALL）患者中得到评估，并与已发表的对照系列进行比较。经过诱导-巩固化疗后，根据风险分层标准和微小残留病（MRD）状态，缓解患者被分配接受维持化疗或早期HCT。在203名研究患者中（中位年龄41岁，范围17-67岁），161例Ph− ALL患者中有140例达到完全缓解（86.9%；≤55岁患者为91.6%，P=0.0002），其中109例患者中有68例实现完全MRD清除；55例患者被分配至维持化疗组，85例因极高危特征（高白细胞血症、不良遗传学、早期/成熟T前体ALL及MRD持续阳性）接受HCT。5年复发率为36%，治疗相关死亡率为18%。中位总生存期和无复发生存期分别为7.4年与6.2年，5年生存率分别为54%和53%，这些结果均显著优于历史方案（P=0.001和P=0.005），而维持化疗组与HCT组之间无显著差异。预后分析显示MRD阴性及年龄≤55岁是最有利的独立预后因素。降低治疗毒性及进一步完善风险定义和风险导向设计是当前研究的重点。

原文链接：

Updated risk-oriented strategy for acute lymphoblastic leukemia in adult patients 18–65 years: NILG ALL 10/07