Chromosomal translocations play a unique role in influencing prognosis in childhood acute lymphoblastic leukemia.
Chromosomal translocations play a unique role in influencing prognosis in childhood acute lymphoblastic leukemia.
复制标题
DOI：
10.1182/blood.v68.1.205.205
复制
发表时间：
1986-07
期刊：
影响因子：
20.3
通讯作者：
D. Williams;J. Harber;S. Murphy;A. Look;D. Kalwinsky;G. Rivera;S. Melvin;S. Stass;G. Dahl
中科院分区：
文献类型：
--
作者：
D. Williams;J. Harber;S. Murphy;A. Look;D. Kalwinsky;G. Rivera;S. Melvin;S. Stass;G. Dahl
某些类型的染色体异常已被证明对急性淋巴细胞白血病（ALL）的治疗结果产生强烈的独立影响。为了确定与预后最密切相关的变化，我们分析了161例儿童此病的完全带状原始细胞核型。125例有一个或多个染色体异常，其中45例显示易位。易位的频率最高（58%）的患者与假二倍体核型和最低（0%）的超二倍体组定义为51条或更多的染色体。在最长6年的随访期间，45例易位患者中有30例治疗失败，而116例缺乏这种特征的患者中只有27例治疗失败。无事件生存的生命表估计表明，只有14%的易位组将在3年完全缓解。与随机和非随机易位相关的失败百分比几乎相同（68%对65%）。当进入考克斯比例风险模型与其他7种类型的染色体异常，然后与11个临床和实验室变量的已知预后价值的ALL，易位成为最强的单一预测治疗结果（P <0.0001）。该模型表明，易位增加了治疗失败的风险6倍，相比没有这个功能。这些发现为儿童ALL的大多数早期治疗失败提供了解释，包括先前归因于倍性分类的那些。
Certain types of chromosomal abnormalities have been shown to exert strong independent influence on treatment outcome in acute lymphoblastic leukemia (ALL). To identify the changes most closely associated with prognosis, we analyzed the completely banded blast cell karyotypes of 161 children with this disease. One hundred twenty-five cases had one or more chromosomal abnormalities, with 45 showing translocations. The frequency of translocations was highest (58%) among patients with pseudodiploid karyotypes and lowest (0%) in the hyperdiploid group defined by 51 or more chromosomes. During the maximum 6-year follow-up period, 30 of the 45 patients with a translocation failed therapy, compared with only 27 of the 116 who lacked this feature. Life-table estimates of event-free survival indicate that only 14% of the translocation group will be in complete remission at 3 years. The percentages of failures associated with random and nonrandom translocations were virtually identical (68% v 65%). When entered in a Cox proportional hazards model with seven other types of chromosomal abnormalities, and then with 11 clinical and laboratory variables of known prognostic value in ALL, translocation emerged as the strongest single predictor of treatment outcome (P less than 0.0001). The model indicated that translocation increases the risk of treatment failure six times by comparison with the absence of this feature. These findings offer an explanation for the majority of early treatment failures in childhood ALL, including those previously attributed to ploidy classification.