| Autor: |
Deng SY; Department of Hematology, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China., Ou JW; Department of Hematology, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China., Huang ZC; Department of Hematology, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China., Chen JJ; Department of Hematology, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China., Cai ZH; Department of Hematology, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China., Liu QF; Department of Hematology, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China., Zhou HS; Department of Hematology, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China. |
| Abstrakt: |
Objective: To reassess the prognostic value of minimal residual disease (MRD) and IKZF1 gene deletions in adults with B-cell acute lymphoblastic leukemia (B-ALL) who received pediatric-specific chemotherapy regimens during the Nanfang Hospital PDT-ALL-2016 trial. Methods: We retrospectively analyzed the prognosis of 149 adult patients with B-ALL who were admitted to Nanfang Hospital from January 2016 to September 2020. Prognostic factors were identified using Cox regression models. Results: The complete remission rate was 93.2% in 149 patients, with a 5-year overall survival (OS) rate of (54.3±5.0) % and a cumulative incidence of relapse (CIR) of (47.5±5.2) %. The Cox regression analysis revealed that MRD positivity at day 45 (MRD(3)) after induction therapy was independently associated with relapse risk ( HR =2.535, 95% CI 1.122-5.728, P =0.025). Deletion of IKZF1 gene was independently associated with mortality risk ( HR =1.869, 95% CI 1.034-3.379, P =0.039). Based on MRD(3) and IKZF1 gene status, we categorized adult patients with B-ALL into the low-risk (MRD(3)-negative and IKZF1 gene deletion-negative) and high-risk (MRD(3)-positive and/or IKZF1 gene wild type) groups. The 5-year OS and CIR rates were (45.5±6.0) % vs (69.4±8.6) % ( P <0.001) and (61.6±8.3) % vs (25.5±6.5) % ( P <0.001), respectively, in the high-risk and low-risk groups, respectively. The multivariate analysis showed that the high-risk group was an independent risk factor for OS ( HR =3.937, 95% CI 1.975-7.850, P <0.001) and CIR ( HR =4.037, 95% CI 2.095-7.778, P <0.001) . Conclusion: The combined use of MRD and IKZF1 gene in prognostic stratification can improve clinical outcome prediction in adult patients with B-ALL, helping to guide their treatment. |
