Trisomy of leukemic cell chromosomes 4 and 10 identifies children with B-progenitor cell acute lymphoblastic leukemia with a very low risk of treatment failure: a Pediatric Oncology Group study.
Trisomy of leukemic cell chromosomes 4 and 10 identifies children with B-progenitor cell acute lymphoblastic leukemia with a very low risk of treatment failure: a Pediatric Oncology Group study.
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DOI：
10.1182/blood.v79.12.3316.3316
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发表时间：
1992-06
期刊：
影响因子：
20.3
通讯作者：
M. Harris;J. Shuster;A. Carroll;A. Look;M. Borowitz;W. Crist;R. Nitschke;J. Pullen;C. Steuber;V. Land
中科院分区：
文献类型：
--
作者：
M. Harris;J. Shuster;A. Carroll;A. Look;M. Borowitz;W. Crist;R. Nitschke;J. Pullen;C. Steuber;V. Land
为了说明超二倍体B祖细胞急性淋巴细胞白血病(ALL)预后好的原因，我们用递归分割分析方法研究了1021例1岁以上儿童中三体对预后的影响。这些患者接受分层随机研究，测试基于抗代谢药物的治疗。在单变量统计分析中，几个个体染色体的三体与较好的预后相关。更重要的是，4号和10号染色体的三体都确定了一组患者(n=180)，他们有非常有利的4年无事件生存(EFS)。根据DNA指数、年龄和白细胞计数对患者进行分层后，4号和10号染色体的联合三体仍具有预测预后的意义。在DNA指数大于1.16的患者中，同时存在4号和10号染色体三体的患者的4年EFS为96.6%(n=161，SE=3.8%)，而这些三体中既无或仅有一个三体的患者的4年EFS为70.4%(n=73，SE=11.5%)。所有19例DNA指数小于或等于1.16但有4号和10号染色体三体的患者仍处于缓解状态，这表明在细胞DNA含量小于或等于1.16预示预后较差的情况下，有利的染色体三体占主导地位。我们的结论是，4号和10号染色体的联合三体可以独立地预测B-祖细胞ALL儿童的EFS。B-祖细胞组中有这一特征的患者(约占克隆异常患者的20%)可能会被基于抗代谢药物的化疗治愈--这种方法应该不会产生明显的后期影响。
To account for the superior prognosis of hyperdiploid, B-progenitor acute lymphoblastic leukemia (ALL), we investigated the influence of trisomy in 1021 children greater than or equal to 1 year old by recursive partitioning analysis. The patients were treated according to a stratified, randomized study testing antimetabolite-based therapies. Trisomies of several individual chromosomes were associated with a better prognosis in a univariate statistical analysis. Of greater importance, trisomy of both chromosomes 4 and 10 identified a subgroup of patients (n = 180) with an extremely favorable 4-year event-free survival (EFS). Combined trisomy of chromosomes 4 and 10 retained its prognostic significance after stratification of patients by DNA index, age, and leukocyte count. Among patients with a DNA index greater than 1.16, patients with trisomies of both chromosomes 4 and 10 had a 4-year EFS of 96.6% (n = 161, SE = 3.8%), whereas patients with neither or only one of these trisomies had a 4-year EFS of 70.4% (n = 73, SE = 11.5%). All 19 patients with a DNA index less than or equal to 1.16 but with trisomies of chromosomes 4 and 10 remain in remission, suggesting that favorable chromosome trisomy dominates in a situation in which the cellular DNA content of less than or equal to 1.16 predicts a less favorable outcome. We conclude that combined trisomy of chromosomes 4 and 10 independently predicts EFS among children with B-progenitor ALL. Patients within the B-progenitor group who have this feature (about 20% of those with clonal abnormalities) are likely to be cured with antimetabolite-based chemotherapy--an approach that should produce few significant late effects.