Steinherz P G, Gaynon P S, Breneman J C, Cherlow J M, Grossman N J, Kersey J H, Johnstone H S, Sather H N, Trigg M E, Chappell R, Hammond D, Bleyer W A
Memorial Sloan-Kettering Cancer Center, New York, NY, USA.
J Clin Oncol. 1996 Feb;14(2):389-98. doi: 10.1200/JCO.1996.14.2.389.
To quantify the residual marrow lymphoblast fraction that best defines patients at high risk for relapse, and the optimal time for assessment during remission induction.
The residual lymphoblast percentage was evaluated on day 7 (n = 220) and day 14 (n = 205) during a four- or five-drug induction in patients with poor prognostic factors. The rate of cytoreduction was related to event-free survival (EFS) and other factors.
On the New York (NY) regimen, 68%, 14%, and 18%, and on the Berlin-Frankfurt-Munster (BFM) regimen, 56%, 15%, and 29% of patients had M1 (< 5% blasts), M2 (5-25%), or M3 (> 25%) responses on day 7 (P = .075). On day 14, the corresponding values were 87%, 6%, 7% on NY and 84%, 8%, 8% on BFM. For patients who achieved remission by day 28 and a day-7 marrow rating of M1, M2, or M3, the 6-year EFS rate was 78%, 61%, and 49% (P < .001). The day-14 ratings predicted for a 72%, 32%, or 40% EFS (P < .001). Patients with 5% to 10% blasts day 7 had three times as many events as those with less than 5% and had no better EFS than those with 11% to 25% blasts. Patients with a WBC count more than 200,000/microL at diagnosis and an M1 day 7 marrow had an EFS rate of 69%, while for those with M2 or M3, the EFS rate was 41%. Day-7 marrow had greater prognostic significance than the day-14 evaluation. For slow responders on day 7, the day-14 marrow provided additional information. EFS for patients who achieved M1 by day 14 was 65%. EFS decreased to 20% for those still M2 or M3 on day 14. Day-7 and -14 evaluations had significance for patients of all ages and WBC levels.
Marrow aspiration on day 7 of therapy provided more useful information than that on day 14. However, day-14 marrow provided additional information for patients with a poor day-7 response. The rate of cytoreduction is a powerful, independent prognostic factor that can identify patients with a slow early response who are at risk for a short remission duration.
量化能最佳界定复发高危患者的残留骨髓淋巴母细胞比例，以及缓解诱导期间的最佳评估时间。
对预后不良因素患者进行四药或五药诱导治疗期间，在第7天（n = 220）和第14天（n = 205）评估残留淋巴母细胞百分比。细胞减少率与无事件生存期（EFS）及其他因素相关。
在纽约（NY）方案中，第7天分别有68%、14%和18%的患者，在柏林 - 法兰克福 - 明斯特（BFM）方案中有56%、15%和29%的患者达到M1（原始细胞<5%）、M2（5% - 25%）或M3（>25%）反应（P = 0.075）。在第14天，NY方案相应数值为87%、6%、7%，BFM方案为84%、8%、8%。对于在第28天达到缓解且第7天骨髓评级为M1、M2或M3的患者，6年EFS率分别为78%、61%和49%（P < 0.001）。第14天评级预测的EFS为72%、32%或40%（P < 0.001）。第7天原始细胞为5%至10%的患者发生事件的次数是原始细胞少于5%患者的三倍，且EFS不比原始细胞为11%至25%的患者更好。诊断时白细胞计数超过200,000/μL且第7天骨髓为M1的患者EFS率为69%，而M2或M3患者的EFS率为41%。第7天骨髓的预后意义大于第14天评估。对于第7天反应缓慢的患者，第14天骨髓提供了额外信息。第14天达到M1的患者EFS为65%。第14天仍为M2或M3的患者EFS降至20%。第7天和第14天评估对所有年龄和白细胞水平的患者均有意义。
治疗第7天的骨髓穿刺比第14天提供了更有用的信息。然而，第14天骨髓为第7天反应不佳的患者提供了额外信息。细胞减少率是一个强大的独立预后因素，可识别早期反应缓慢且缓解期短风险高的患者。
