METHODS: A total of 485 children with non-high-risk BCP-ALL with available cytogenetic data and MRD studied at the end-of-induction (EOI) by multicolor flow cytometry (MFC) were included. All patients were treated with standard-risk (SR) of intermediate-risk (ImR) regimens of \"ALL-MB 2008\" reduced-intensity protocol.
CONCLUSIONS: Among all study group patients, 203 were found to have low-risk cytogenetics (ETV6::RUNX1 or high hyperdiploidy), while remaining 282 children were classified in intermediate cytogenetic risk group. For the patients with favorable and intermediate risk cytogenetics, the most significant thresholds for MFC-MRD values were different: 0.03% and 0.04% respectively. Nevertheless, the most meaningful thresholds were different for clinically defined SR and ImR groups. For the SR group, irrespective to presence/absence of favorable genetic lesions, MFC-MRD threshold of 0.1% was the most clinically valuable, although for ImR group the most informative thresholds were different in patients from low-(0.03%) and intermediate (0.01%) cytogenetic risk groups.
CONCLUSIONS: Our data show that combining clinical risk factors with MFC-MRD measurement is the most useful tool for risk group stratification of children with BCP-ALL in the reduced-intensity protocols. However, this algorithm can be supplemented with cytogenetic data for part of the ImR group.
方法:纳入了485名非高危BCP-ALL患儿,这些患儿具有可用的细胞遗传学数据,并通过多色流式细胞术(MFC)在诱导末期(EOI)进行了MRD研究。所有患者均接受“ALL-MB2008”降低强度方案的标准风险(SR)中危(ImR)方案治疗。
结论:在所有研究组患者中,发现203具有低风险的细胞遗传学(ETV6::RUNX1或高超二倍体),而其余282名儿童被归类为中等细胞遗传学风险组。对于具有有利和中等风险细胞遗传学的患者,MFC-MRD值的最显著阈值不同:分别为0.03%和0.04%.然而,临床定义的SR和ImR组的最有意义的阈值不同.对于SR组,无论是否存在/不存在有利的遗传病变,MFC-MRD阈值为0.1%是最具临床价值的,尽管ImR组的信息最丰富的阈值在低(0.03%)和中等(0.01%)细胞遗传学风险组的患者中不同.
结论:我们的数据表明,将临床危险因素与MFC-MRD测量相结合是降低强度方案中BCP-ALL儿童风险组分层的最有用工具。然而,该算法可以补充部分ImR组的细胞遗传学数据.