Cherian Thomas, John Rikki, Joseph Leenu Lizbeth, Srinivasan Hema N, Boddu Deepthi, Geevar Tulasi, Mathew Leni Grace, Totadri Sidharth
Paediatric Haematology-Oncology Unit, Department of Paediatrics, Christian Medical College and Hospital, Vellore, India.
Department of Transfusion Medicine and Immunohaematology, Christian Medical College, Vellore, India.
Indian J Hematol Blood Transfus. 2021 Jul;37(3):366-371. doi: 10.1007/s12288-020-01354-0. Epub 2020 Sep 13.
Risk-stratification has contributed to a dramatic improvement in survival in pediatric acute lymphoblastic leukemia (ALL). This study evaluated the utility of prephase response and day 15 bone marrow when a minimal residual disease (MRD) assessment was available. A file review of children aged ≤ 15 years diagnosed with precursor-B ALL from 2014 to 2019 was performed. The protocol used for risk stratification and treatment was based on a UKALL-2003 backbone. All patients received one week of prephase therapy comprised of intravenous dexamethasone in the first 48 h followed by oral prednisolone. The median age of the 255 patients in the study was 5 years. Following the prephase, the peripheral blood absolute blast count was 0 and ≥ 1000/µL blasts in 141 (56%) and 29 (11%), respectively. Ten of 199 (5%) patients with an evaluable day 15 bone marrow had M3 status. At the end of induction, 30 (12%), 127 (50%) and 98 (38%) patients belonged to the standard-risk, intermediate-risk and high-risk (HR) groups, respectively. An M3 day15 bone marrow was the sole reason for escalation in three (3%) of the patients in the HR group. A lack of complete clearance of peripheral blood blasts post-prephase [HR: 2.45 (1.04-5.75), = 0.040] and a positive MRD [HR: 3.00 (1.28-7.02), = 0.011] independently predicted risk of relapse. Complete blast clearance is superior to the traditional cut-off of 1000/µL in predicting relapse. The role of a day 15 bone marrow morphology is diminished when an end of induction MRD is available.
风险分层显著改善了儿童急性淋巴细胞白血病（ALL）的生存率。本研究评估了在可进行微小残留病（MRD）评估时，前期反应和第15天骨髓情况的效用。对2014年至2019年诊断为前体B-ALL的≤15岁儿童进行了病历回顾。用于风险分层和治疗的方案基于UKALL - 2003框架。所有患者接受为期一周的前期治疗，在前48小时静脉注射地塞米松，随后口服泼尼松龙。该研究中255例患者的中位年龄为5岁。前期治疗后，外周血原始细胞绝对计数为0以及≥1000/µL原始细胞的患者分别有141例（56%）和29例（11%）。199例可评估第15天骨髓情况的患者中有10例（5%）处于M3状态。诱导结束时，分别有30例（12%）、127例（50%）和98例（38%）患者属于标准风险、中风险和高风险（HR）组。第15天骨髓M3状态是HR组中3例（3%）患者治疗升级的唯一原因。前期治疗后外周血原始细胞未完全清除[HR：2.45（1.04 - 5.75），P = 0.040]和MRD阳性[HR：3.00（1.28 - 7.02），P = 0.011]独立预测复发风险。在预测复发方面，完全清除原始细胞优于传统的1000/µL临界值。当有诱导结束时的MRD结果时，第15天骨髓形态学的作用减弱。
