Prospective evaluation of gene mutations and minimal residual disease in patients with core binding factor acute myeloid leukemia
Prospective evaluation of gene mutations and minimal residual disease in patients with core binding factor acute myeloid leukemia
复制标题
DOI：
10.1182/blood-2012-10-462879
复制
发表时间：
2013-03-21
期刊：
影响因子：
20.3
通讯作者：
Dombret, Herve
中科院分区：
文献类型：
--
作者：
Jourdan, Eric;Boissel, Nicolas;Dombret, Herve
并不是所有的核心结合因子急性髓系白血病(CBF-AML)患者都表现出良好的预后。现代危险因素包括KIT和/或Flt3基因突变和最小残留病(MRD)水平，但它们各自的值从未被前瞻性评估。共有198名CBF-AML患者被随机分为强化诱导疗程和标准诱导疗程，然后是3个大剂量阿糖胞苷巩固疗程。前瞻性监测MRD水平。在诊断时进行基因突变筛查。尽管强化诱导后MRD下降较快，诱导组对无复发生存率(RFS)无影响(双侧%；P=.91)。较高的WBC、KIT和/或Flt3-ITD/TKD基因突变，以及首次巩固后MRD减少不到3个对数，与较高的特定复发风险相关，但在多因素分析中，MRD仍然是唯一的预后因素。36个月时累积复发率和RFS发生率分别为22%和54%(P
Not all patients with core binding factor acute myeloid leukemia (CBF-AML) display a good outcome. Modern risk factors include KIT and/or FLT3 gene mutations and minimal residual disease (MRD) levels, but their respective values have never been prospectively assessed. A total of 198 CBF-AML patients were randomized between a reinforced and a standard induction course, followed by 3 high-dose cytarabine consolidation courses. MRD levels were monitored prospectively. Gene mutations were screened at diagnosis. Despite a more rapid MRD decrease after reinforced induction, induction arm did not influence relapse-free survival (RFS) (64% in both arms; P = .91). Higher WBC, KIT, and/or FLT3-ITD/TKD gene mutations, and a less than 3-log MRD reduction after first consolidation, were associated with a higher specific hazard of relapse, but MRD remained the sole prognostic factor in multivariate analysis. At 36 months, cumulative incidence of relapse and RFS were 22% vs 54% (P