Ramos Peñafiel Christian Omar, Pérez Sámano Daniela, Gallardo Rodríguez Adán Germán, Terreros Palacio Camila, Olarte Carrillo Irma, Martínez Murillo Carlos, Barranco Lampón Gilberto, Cabrera García Álvaro, Martínez Tovar Adolfo
Hematology Department, General Hospital of Mexico "Dr. Eduardo Liceaga, Mexico City, Mexico.
Hematology Department, Regional Hospital of High Specialty of Ixtapaluca, State of Mexico, Mexico City, Mexico.
Blood Res. 2025 Jan 14;60(1):4. doi: 10.1007/s44313-024-00050-6.
Despite advances in the treatment of adult acute lymphoblastic leukemia (ALL), relapse remains the most significant challenge in improving prognosis. Measurable residual disease (MRD) assessment can predict bone marrow relapse based on MRD positivity. As access to innovative therapies remains limited because of the high cost, chemotherapy is the widely utilized treatment option. The efficacy of a combination of bortezomib and Hyper-CVAD has been reported in patients with multiple myeloma; however, its efficacy has not yet been confirmed in patients with ALL.
This prospective cohort study involved patients with ALL who presented with MRD-positive results or relapse and received treatment with a combination of bortezomib and Hyper-CVAD at two reference centers in Mexico City.
Of the 20 patients with positive MRD included in this study, 60% (n = 12) exhibited MRD negative results after combination treatment, 30% (n = 6) persisted positive MRD results, and 10% (n = 2) passed away. Of the 23 patients with bone marrow relapse, 43.5% (n = 10) achieved a second complete remission (2CR), 34.8% (n = 6) exhibited refractory status, and 21.7% (n = 5) passed away. To achieve a 2CR, 20% (n = 2) patients required less than four cycles of treatment, 50% (n = 5) required four cycles (two A and B cycles each), and 30% (n = 3) required six cycles.
The combination of bortezomib and Hyper-CVAD treatment exhibited better results in achieving MRD negative results, indicating its potential as a promising first-line treatment strategy for ALL.
尽管成人急性淋巴细胞白血病（ALL）的治疗取得了进展，但复发仍然是改善预后的最重大挑战。可测量残留病（MRD）评估可根据MRD阳性预测骨髓复发。由于创新疗法成本高昂，其可及性仍然有限，化疗是广泛使用的治疗选择。硼替佐米与Hyper-CVAD联合使用的疗效已在多发性骨髓瘤患者中得到报道；然而，其在ALL患者中的疗效尚未得到证实。
这项前瞻性队列研究纳入了在墨西哥城两个参考中心接受硼替佐米与Hyper-CVAD联合治疗的MRD阳性或复发的ALL患者。
本研究纳入的20例MRD阳性患者中，60%（n = 12）在联合治疗后MRD结果为阴性，30%（n = 6）MRD结果仍为阳性，10%（n = 2）死亡。在23例骨髓复发患者中，43.5%（n = 10）实现了第二次完全缓解（2CR），34.8%（n = 6）表现为难治状态，21.7%（n = 5）死亡。为实现2CR，20%（n = 2）的患者需要少于四个周期的治疗，50%（n = 5）需要四个周期（每个周期包括两个A和B周期），30%（n = 3）需要六个周期。
硼替佐米与Hyper-CVAD联合治疗在实现MRD阴性结果方面表现出更好的效果，表明其作为ALL有前景的一线治疗策略的潜力。
