文章：

诱导治疗初期单次使用聚乙二醇化门冬酰胺酶不仅加速微小残留病清除，还改善B系急性淋巴细胞白血病患儿的长期预后

A Single Dose of PEG-Asparaginase at the Beginning of Induction Not Only Accelerates MRD Clearance but Also Improves Long-Term Outcome in Children with B-Lineage ALL

原文发布日期：23 November 2023

DOI: 10.3390/cancers15235547

类型: Article

开放获取: 是

英文摘要：

This report presents the results of the assessment of MRD response by multicolor flow cytometry (MFC) with regard to the randomized use of pegylated asparaginase (PEG). In this study, PEG was randomly administered at a dose of 1000 U/m2on day 3 of induction therapy in children with B-lineage ALL. Methods. Conventional induction therapy consisted of dexamethasone, vincristine, and daunorubicin. MRD data was available in 502 patients who were randomized at the start of induction therapy, standard-risk (SR) patients into three (conventional induction without PEG, induction with additional PEG and with PEG but without daunorubicin) and intermediate-risk (ImR) patients into two groups (with additional PEG and without PEG). Results. The single administration of PEG resulted in a significantly higher proportion of rapid responders, in SR patients even when no anthracyclines were used for induction. In the SR group, the event-free survival of the MFC-MRD fast responders was similar in the PEG− and PEG+ arms (92.0 ± 3.1% vs. 96.2 ± 1.5%, respectively), and the same unfavorable trend was observed for MFC-MRD slow responders (57.5 ± 12.3% vs. 66.7 ± 15.7%, respectively). Results were similar in ImR patients: (94.3 ± 3.2% vs. 95.1 ± 2.4%, for fast responders and 63.3 ± 7.6% vs. 78.1 ± 7.9%, for slow responders in PEG− and PEG+ arms, respectively). However, there is a large difference between the proportion of MFC-MRD slow responders in the PEG− and PEG+ groups (18.3% vs. 5.2% for the SR group and 44.2% vs. 25.0% for the ImR group). Conclusions. Therefore, early use of PEG-ASP not only leads to an accelerated reduction of blasts, but also to an excellent outcome in a significantly larger proportion of patients in both risk groups.

摘要翻译： 

本报告通过多色流式细胞术（MFC）评估了聚乙二醇化门冬酰胺酶（PEG）随机使用对微小残留病（MRD）反应的影响。本研究在B系急性淋巴细胞白血病（ALL）儿童患者中，于诱导治疗第3天随机给予1000 U/m²剂量的PEG。方法：常规诱导治疗方案包括地塞米松、长春新碱和柔红霉素。共有502例在诱导治疗开始时随机分组的患者获得MRD数据，其中标危组（SR）患者分为三组（常规诱导不加PEG、诱导加用PEG、以及使用PEG但不用柔红霉素），中危组（ImR）患者分为两组（加用PEG与不加PEG）。结果：单次使用PEG显著提高了快速反应者的比例，在SR患者中即使未使用蒽环类药物进行诱导亦如此。SR组中，MFC-MRD快速反应者的无事件生存率在PEG-组与PEG+组间相近（分别为92.0 ± 3.1% vs. 96.2 ± 1.5%），而MFC-MRD缓慢反应者也呈现相同的不利趋势（分别为57.5 ± 12.3% vs. 66.7 ± 15.7%）。ImR患者结果相似：快速反应者在PEG-组与PEG+组分别为94.3 ± 3.2% vs. 95.1 ± 2.4%，缓慢反应者分别为63.3 ± 7.6% vs. 78.1 ± 7.9%。然而，PEG-组与PEG+组间MFC-MRD缓慢反应者比例存在显著差异（SR组为18.3% vs. 5.2%，ImR组为44.2% vs. 25.0%）。结论：因此，早期使用PEG-ASP不仅能加速原始细胞的清除，还能使两个风险组中显著更高比例的患者获得优异疗效。

原文链接：

A Single Dose of PEG-Asparaginase at the Beginning of Induction Not Only Accelerates MRD Clearance but Also Improves Long-Term Outcome in Children with B-Lineage ALL