Early peripheral blood blast clearance during induction chemotherapy for acute myeloid leukemia predicts superior relapse-free survival
Early peripheral blood blast clearance during induction chemotherapy for acute myeloid leukemia predicts superior relapse-free survival
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DOI：
10.1182/blood-2007-07-104091
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发表时间：
2007-12-15
期刊：
影响因子：
20.3
通讯作者：
Tallman, Martin S.
中科院分区：
文献类型：
--
作者：
Elliott, Michelle A.;Litzow, Mark R.;Tallman, Martin S.
在儿童急性淋巴细胞性白血病(ALL)中，诱导化疗或强的松治疗后循环白血病原始细胞的迅速减少是最重要的预后因素之一，这不仅关系到病情的缓解，而且关系到无复发生存(RFS)。然而，在急性髓系白血病(AML)中，化疗敏感性的参数主要限于完全缓解(CR)的速度或评估再生障碍性白血病(AML)期间残留的白血病骨髓原始细胞。我们假设，作为体内化疗敏感性的潜在替代物，外周血细胞清除的循环时间也将与AML的预后相关。在对86例接受统一诱导和巩固化疗的成人AML患者的回顾性分析中，我们证明在诱导化疗过程中循环母细胞清除的时间是RFS的独立预后标志，取代了其他已知或已确定的危险因素，包括核型和获得CR的诱导次数。
In childhood acute lymphoblastic leukemia (ALL), a rapid decline of circulating leukemic blasts in response to induction chemotherapy or prednisone is one of the most important prognostic factors, not only for achieving remission but also for relapse-free survival (RFS). However, in acute myeloid leukemia (AML) parameters of chemosensitivity have been restricted mainly to the rapidity of achievement of complete remission (CR) or the assessment of residual leukemic bone marrow blasts during aplasia. We hypothesized that the time to circulating peripheral blood blast clearance, as a potential surrogate for in vivo chemosensitivity, would have prognostic relevance in AML also. In a retrospective analysis of a cohort of 86 adult patients with AML receiving uniform induction and consolidation chemotherapy, we demonstrate that the time to clearance of circulating blasts during induction chemotherapy is an independent prognostic marker of RFS, superseding other known or established risk factors, including karyotype and number of inductions to achieve CR.