成人急性淋巴细胞白血病的治疗—ASH点滴.ppt

四. 成人ALL的靶向治疗 Ab 2714 ?Persistence of the Minimal Residual Disease at the End of Induction Is Not a Factor of Poor Prognosis If Imatinib Was Changed to the Dasatinib By Ph+ RALL Protocol in Ph-Positive Acute Lymphoblastic Leukemia Patients Olga A. Gavrilina (Russia), 如果在第70天仍未取得MMR，IM换为达沙替尼。 143?Inotuzumab Ozogamicin in Combination with Bosutinib for Patients with Relapsed or Refractory Ph+ ALL or CML in Lymphoid Blast Phase Nitin Jain (MDACC) Ab 1322?Ruxolitinib or Dasatinib in Combination with Chemotherapy for Patients with Relapsed/Refractory Philadelphia (Ph)-like Acute Lymphoblastic Leukemia: A Phase I-II Trial Nitin Jain (MDACC) 五. 预后相关——MRD 2017ASH Ab139: ?Evaluation of Minimal Residual Disease (MRD) and MRD-Based Treatment Decisions in Ph/BCR-ABL Negative Adult Acute Lymphoblastic Leukemia (ALL): Experience from the German Multicenter Study Group for Adult ALL (GMALL) Nicola Goekbuget Protocol 07/03 (within the trial or in GMALL registry). MRD was tested by real-time PCR of clonal TCR and Ig gene rearrangements Analysis refers to molecular response in wk 16 after induction/1st consolidation and to molecular relapse (MolR) later than wk 16 Molecular CR (MolCR): ≤10 -4 Molecular failure (MolF): 10 -4 MRDneg：MRD(-)，但敏感度不够 MRDpos： detectable (MRD 10 -4) 或无定量MRD MolR：取得MolCR的患者在16W以后又出现MRD 10 -4  MolCR MolF MRDneg MRDpos MolR5年OS 83% 43% 78% 68% 51%5年CCR 80% 38% 76% 56% 35% 121/196(62%) MolF患者在CR1行SCT  non-SCT SCT5年OS 28% 53%5年CCR 9% 56% Ab139 结 论 It is demonstrated that pts with any detectable MRD (MRDpos) have an intermediate prognosis and require regular follow-up MRD testing SCT offers an advantage in MolF and MolR pts Evidence was provided that later SCT (i.e. in better molecular status) could be superior to immediate SCT Compliance with MRD testing and SCT in MolF increased over time Man