Department of Pharmaceutical Sciences, St. Jude Children's Research Hospital, Memphis, Tennessee.
Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee.
Pediatr Blood Cancer. 2019 Jun;66(6):e27681. doi: 10.1002/pbc.27681. Epub 2019 Mar 7.
BACKGROUND/OBJECTIVES: Anthracyclines are used in induction therapy of pediatric acute lymphoblastic leukemia (ALL) and are known to generate oxidative stress; whether this translates into enhanced antileukemic activity or hemolytic effects in patients with glucose-6-phosphate dehydrogenase (G6PD) deficiency is unknown.
DESIGN/METHODS: Among 726 pediatric patients with newly diagnosed ALL treated at St. Jude Children's Research Hospital, 22 had deficient G6PD activity. We compared the prevalence of positive minimal residual disease (MRD) ≥1% at Day 15/Day 19 of induction or ≥0.01% at Day 42/Day 46 (end of induction) and the number of red blood cell (RBC) transfusions after daunorubicin in induction between patients with or without G6PD deficiency, adjusting for ALL risk group, treatment protocol, age, and gender.
There was no difference in Day 15/19 (P = 1) or end of induction MRD (P = 0.76) nor in the number of RBC transfusions (P = 0.73); the lack of association with MRD was confirmed in a dataset of 1192 newly diagnosed male patients enrolled in a Children's Oncology Group trial (P = 0.78).
We found no evidence that G6PD deficiency affects daunorubicin activity during induction treatment for ALL.
背景/目的：蒽环类药物用于儿童急性淋巴细胞白血病（ALL）的诱导治疗，已知其会产生氧化应激；然而，在葡萄糖-6-磷酸脱氢酶（G6PD）缺乏症患者中，这种氧化应激是否会转化为增强的抗白血病活性或溶血作用尚不清楚。
方法/设计：在圣裘德儿童研究医院接受新诊断的 ALL 治疗的 726 名儿科患者中，有 22 名患者的 G6PD 活性不足。我们比较了诱导治疗第 15/19 天（Day 15/19）或第 42/46 天（诱导结束时）微小残留病（MRD）阳性≥1%的患者比例，以及在诱导治疗中使用柔红霉素后红细胞（RBC）输注的数量，在 G6PD 缺乏症患者和非 G6PD 缺乏症患者之间，同时调整 ALL 风险组、治疗方案、年龄和性别。
Day 15/19 时（P=1）或诱导结束时（P=0.76）MRD 没有差异，也没有 RBC 输注数量的差异（P=0.73）；在儿童肿瘤组一项纳入 1192 名新诊断男性患者的临床试验数据集（Children's Oncology Group trial）中，这种与 MRD 缺乏的关联也得到了确认（P=0.78）。
我们没有发现证据表明 G6PD 缺乏会影响 ALL 诱导治疗期间柔红霉素的活性。
