Paediatric Oncology/Haematology, VU University Medical Center (VUmc), Amsterdam, The Netherlands.
Pediatr Blood Cancer. 2012 Dec 15;59(7):1239-44. doi: 10.1002/pbc.24124. Epub 2012 Feb 29.
The outcome of the treatment of pediatric acute myeloid leukemia (AML) is still disappointing, due to relatively high treatment-related mortality and relapse rates (30-40%). Past treatment protocols have called for routine screening via bone marrow aspiration (BMA) after achievement of first complete remission (CR1) to detect relapse at an early stage. However, supporting evidence for this policy is lacking for non-FAB type-M3 patients.
We therefore retrospectively studied the clinical relevance of routine BMA in an unselected cohort of all pediatric AML patients in the Netherlands.
Of 440 patients, data for 349 patients, of whom 148 suffered bone marrow relapse (BM-relapse), could be analyzed. A total of 1,790 BMAs had been performed, 1,648 (92%) routinely, and 142 (8%) on indication when a relapse was suspected. Forty routine BMAs showed BM-relapse (2% of all routine BMAs), while as many as 108 (76%) hematological relapses were confirmed by BMA on indication (P < 0.001). Therefore, 1 in 41 routine BMAs, as opposed to 1 in 1.3 BMAs performed on indication, detected a BM-relapse.
Routine BMA after CR1 did not significantly contribute to early detection of relapsed AML. These results suggest that BMA after achievement of CR1 should only be performed on indication or within a clinical research setting. Pediatr Blood Cancer 2012; 59: 1239-1244. © 2012 Wiley Periodicals, Inc.
由于治疗相关的死亡率和复发率（30-40%）相对较高，儿科急性髓系白血病（AML）的治疗效果仍然不尽如人意。过去的治疗方案要求在达到首次完全缓解（CR1）后通过骨髓穿刺（BMA）进行常规筛查，以早期发现复发。然而，对于非 FAB 型-M3 患者，缺乏支持这一政策的证据。
因此，我们回顾性地研究了常规 BMA 在荷兰所有儿科 AML 患者未选择队列中的临床相关性。
在 440 例患者中，有 349 例患者的数据（其中 148 例发生骨髓复发[BM 复发]）可进行分析。共进行了 1790 次 BMA，其中 1648 次（92%）为常规进行，142 次（8%）是在怀疑复发时进行的。40 次常规 BMA 显示 BM 复发（所有常规 BMA 的 2%），而多达 108 次（76%）血液学复发是通过指示性 BMA 确认的（P < 0.001）。因此，在 41 次常规 BMA 中，有 1 次检测到 BM 复发，而在指示性进行的 13 次 BMA 中，有 1 次检测到 BM 复发。
CR1 后常规 BMA 并不能显著提高复发 AML 的早期检出率。这些结果表明，CR1 后 BMA 仅应在指示或临床研究环境下进行。儿科血液学杂志 2012；59：1239-1244。© 2012 Wiley Periodicals, Inc.
