Sử dụng tiềm năng phân tích phân tử về bệnh dư thừa tối thiểu để phân loại nguy cơ ở trẻ em và thanh thiếu niên mắc bệnh bạch cầu lymphoblastic cấp tính

Wiener klinische Wochenschrift - Trang 1-14 - 2023
Leila Ronceray1, Michael Dworzak1,2, Karin Dieckmann3, Georg Ebetsberger-Dachs4, Evgenia Glogova2, Oskar A. Haas2,5, Neil Jones6, Karin Nebral2,5, Reinhard Moser7, Thomas Lion2,5, Bernhard Meister8, Renate Panzer-Grümayer2, Sabine Strehl2, Christina Peters1, Ulrike Pötschger2, Christian Urban9, Georg Mann1,2, Andishe Attarbaschi1,2
1Department of Pediatric Hematology and Oncology, St. Anna Children's Hospital, Medical University of Vienna, Vienna, Austria
2St. Anna Children’s Cancer Research Institute (CCRI), Vienna, Austria
3Department of Radiotherapy, Medical University of Vienna, Vienna, Austria
4Department of Pediatrics and Adolescent Medicine, Kepler University Hospital Linz, Linz, Austria
5Labdia Labordiagnostik, Vienna, Austria
6Department of Pediatrics and Adolescent Medicine, University Clinics Salzburg, Salzburg, Austria
7Department of Pediatrics and Adolescent Medicine, State Hospital Leoben, Leoben, Austria
8Department of Pediatrics I, Medical University of Innsbruck, Innsbruck, Austria
9Division of Pediatric Hematology and Oncology, Department of Pediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria

Tóm tắt

Kể từ năm 1979, trẻ em và thanh thiếu niên Áo mắc bệnh bạch cầu lymphoblastic cấp tính (ALL) đã được điều trị theo các quy trình của nhóm nghiên cứu Berlin-Frankfurt-Münster (BFM). Nghiên cứu AIEOP-BFM ALL 2000 được thiết kế nhằm nghiên cứu một cách có hệ thống việc phân loại bệnh nhân thành ba nhóm nguy cơ dựa trên bệnh dư thừa tối thiểu (MRD) tại hai thời điểm trong quá trình phát triển bệnh ban đầu của bệnh nhân. Mức độ MRD được theo dõi bằng cách phát hiện các biến thể cụ thể của các gen immunoglobulin và thụ thể tế bào T thông qua một kỹ thuật phản ứng chuỗi polymerase định lượng. Tỷ lệ sống sót không sự kiện (EFS) và tỷ lệ sống sót toàn bộ cho toàn bộ 608 bệnh nhân Áo được điều trị từ tháng 6 năm 1999 đến tháng 12 năm 2009 trong khuôn khổ nghiên cứu AIEOP-BFM 2000 lần lượt là 84 ± 2% và 91 ± 1%, với thời gian quan sát trung bình là 6.58 năm. Tỷ lệ sống sót không sự kiện cho bệnh nhân đang điều trị bạch cầu B và tế bào T cấp tính lần lượt là 84 ± 2% (n = 521) và 84 ± 4% (n = 87; p = 0.460). Đánh giá MRD có thể thực hiện trên 94% bệnh nhân và cho phép định nghĩa bệnh nhân ALL tiền cấp B với nguy cơ tái phát thấp, trung bình hoặc cao ngay cả trên các nhóm con lâm sàng có liên quan. Một phát hiện tương tự về mối liên quan của MRD ở bệnh nhân T-ALL không thể thực hiện do số lượng bệnh nhân và các sự kiện nhỏ. Kể từ thử nghiệm quốc tế quan trọng AIEOP-BFM ALL 2000 này, phản ứng phân tử với điều trị đã được sử dụng liên tục và có thêm các tinh chỉnh để phân loại bệnh nhân thành các nhóm nguy cơ khác nhau trong tất cả các thử nghiệm kế tiếp của nhóm nghiên cứu AIEOP-BFM ALL.

Từ khóa

#bạch cầu lymphoblastic cấp tính #bệnh dư thừa tối thiểu #phân loại nguy cơ

Tài liệu tham khảo

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