Updated risk-oriented strategy for acute lymphoblastic leukemia in adult patients 18-65 years: NILG ALL 10/07.
Updated risk-oriented strategy for acute lymphoblastic leukemia in adult patients 18-65 years: NILG ALL 10/07.
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DOI：
10.1038/s41408-020-00383-2
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发表时间：
2020-11-13
影响因子：
12.8
通讯作者：
Rambaldi A
中科院分区：
文献类型：
--
作者：
Bassan R;Pavoni C;Intermesoli T;Spinelli O;Tosi M;Audisio E;Marmont F;Cattaneo C;Borlenghi E;Cortelazzo S;Cavattoni I;Fumagalli M;Mattei D;Romani C;Cortelezzi A;Fracchiolla N;Ciceri F;Bernardi M;Scattolin AM;Depaoli L;Masciulli A;Oldani E;Rambaldi A
在费城染色体阴性急性淋巴细胞白血病（Ph− ALL）中评价了一种将基于儿科的化疗与风险导向的异基因造血细胞移植（HCT）相结合的更新策略，并与已发表的对照系列进行了比较。诱导巩固化疗后，根据风险分层标准和微小残留病（MRD）状态，将应答患者分配接受维持化疗或接受早期HCT。在203名研究患者中，（中位年龄41岁，范围17-67），140/161例Ph− ALL患者达到完全缓解（86.9%; 91.6% ≤55岁，P = 0.0002），68/109例MRD完全清除; 55名患者被分配接受维持化疗，85名患者由于非常高的风险特征而被分配接受HCT（白细胞增多症、不良遗传学、早期/成熟T前体ALL和MRD持续性）。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年和6.2年，5年生存率分别为54%和53%，显著优于历史方案（分别为P = 0.001和P = 0.005），维持和HCT队列之间无显著差异。在预后分析中，MRD阴性和年龄≤55岁是最有利的独立预后因素。降低治疗毒性和进一步改进风险定义和风险导向设计是这项正在进行的研究的重点。
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.
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影响因子：
20.3
作者：
Brüggemann, M;Raff, T;Kneba, M
通讯作者：
Kneba, M
影响因子：
10.1
作者：
Chiaretti S;Messina M;Della Starza I;Piciocchi A;Cafforio L;Cavalli M;Taherinasab A;Ansuinelli M;Elia L;Albertini Petroni G;La Starza R;Canichella M;Lauretti A;Puzzolo MC;Pierini V;Santoro A;Spinelli O;Apicella V;Capria S;Di Raimondo F;De Fabritiis P;Papayannidis C;Candoni A;Cairoli R;Cerrano M;Fracchiolla N;Mattei D;Cattaneo C;Vitale A;Crea E;Fazi P;Mecucci C;Rambaldi A;Guarini A;Bassan R;Foà R
通讯作者：
Foà R
影响因子：
28.4
作者：
Berry, Donald A.;Zhou, Shouhao;Radich, Jerald P.
通讯作者：
Radich, Jerald P.
DOI：
10.1038/sj.thj.6200032
发表时间：
2000-01-01
期刊：
The hematology journal : the official journal of the European Haematology Association
影响因子：
--
作者：
Bassan, R;Rohatiner, A Z;Barbui, T
通讯作者：
Barbui, T
影响因子：
50.5
作者：
Hoelzer, D.;Bassan, R.;Buske, C.
通讯作者：
Buske, C.