Augmented therapy improves outcome for pediatric high risk acute lymphocytic leukemia: results of Children's Oncology Group trial P9906.
Augmented therapy improves outcome for pediatric high risk acute lymphocytic leukemia: results of Children's Oncology Group trial P9906.
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DOI：
10.1002/pbc.22944
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发表时间：
2011-10
影响因子：
3.2
通讯作者：
Borowitz, Michael J.
中科院分区：
文献类型：
--
作者：
Bowman, W. Paul;Larsen, Eric L.;Devidas, Meenakshi;Linda, Stephen B.;Blach, Laurie;Carroll, Andrew J.;Carroll, William L.;Pullen, D. Jeanette;Shuster, Jonathan;Willman, Cheryl L.;Winick, Naomi;Camitta, Bruce M.;Hunger, Stephen P.;Borowitz, Michael J.
增强的BFM方案改善了NCI高度急性淋巴细胞白血病(ALL)儿童的预后。患者的年龄、性别和目前的白细胞计数(WBC)可以用来确定在早期的儿科肿瘤学小组(POG)试验中，大约12%的B-前体ALL儿童的5年持续完全缓解(CCR)率仅为50%。儿童肿瘤学小组试验P9906在267名具有特别高风险B-前体ALL的患者中评估了一种改进的增强BFM方案。在诱导后第8天和第29天分别检测血液和骨髓中微小残留病(MRD)，并与结果相关。P9906患者的5年CCR概率明显好于POG8602/9006试验的类似患者(62.2±3.7%对50.6±2.4%；p=0.0007)，但与POG9406相似(63.5±2.4%；p=0.81)。中期分析显示中枢神经系统(CNS)控制较差，特别是在初始白细胞≥为100,000/微升的患者。骨髓MRD阳性与阴性患者第29天的5年CCR率分别为37.1±7.4%与72.6±4.3%，第8天骨髓MRD阳性与阴性患者的5年CCR率分别为57.1±4.6%与83.6±6.3%。诱导结束时骨髓MRD可预测骨髓复发，但不能预测中枢神经系统复发。在多因素分析中，第29天MRD和GT；0.01%、初始白细胞≥100,000/µL、男性、第8天血MRD和GT；0.01%是有意义的预后因素。加强的BFM治疗改善了高危ALL儿童的预后。第8天的血液和第29天的骨髓MRD是这些患者的强烈预后因素。
The augmented BFM regimen improves outcome for children with NCI high acute lymphoblastic leukemia (ALL). Patient age, sex, and presenting white blood cell count (WBC) can be used to identify a subset of approximately 12% of children with B-precursor ALL that had a 5-year continuous complete remission (CCR) rate of only about 50% on earlier Pediatric Oncology Group (POG) trials. Children’s Oncology Group trial P9906 evaluated a modified augmented BFM regimen in 267 patients with particularly high risk B-precursor ALL. Minimal residual disease (MRD) was assessed in blood at day 8 and in marrow at day 29 of Induction and correlated with outcome. The 5-year CCR probability for patients in P9906 was significantly better than that observed for similar patients on POG trials 8602/9006 (62.2 ±3.7% versus 50.6 ±2.4%; p=0.0007) but similar to POG 9406 (63.5±2.4%; p=0.81). Interim analysis showed poor central nervous system (CNS) control, especially in patients with initial WBC ≥100,000/microliter. Day 29 marrow MRD positive (>=0.01%) vs. negative patients had 5 year CCR rates of 37.1±7.4% vs. 72.6±4.3%; day 8 blood MRD positive vs. negative patients had 5 year CCR rates of 57.1 ±4.6 % vs.83.6±6.3%. End induction marrow MRD predicted marrow but not CNS relapse. In multivariate analysis, day 29 MRD>0.01%, initial WBC≥100,000/µl, male gender, and day 8 blood MRD>0.01% were significant prognostic factors. Augmented BFM therapy improved outcome for children with higher risk ALL. Day 8 blood and day 29 marrow MRD were strong prognostic factors in these patients.
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影响因子：
20.3
作者：
Brüggemann, M;Raff, T;Kneba, M
通讯作者：
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20.3
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作者：
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Campana, D