克隆进化定义了成人急性淋巴细胞白血病中中枢神经系统白血病的风险分层
Jia Li1, Junjie Chen1, Qiang Wang1
1Department of Hematology, Nanfang Hospital, Southern Medical University, Guangzhou, China.
Annals of hematology
|November 28, 2024
概括
中枢神经系统白血病 (CNSL) 在急性淋巴细胞白血病 (ALL) 中具有预后异质性. 这项研究开发了CNSL的风险分类,根据克隆进化确定了不同的高风险和标准风险子组.
科学领域:
- 血液学 血液学 血液学
- 在瘤学瘤学.
- 分子生物学分子生物学
背景情况:
- 中枢神经系统白血病 (CNSL) 是急性淋巴细胞白血病 (ALL) 的已知不良预后因素.
- 在CNSL内部的预测异质性需要进一步调查,以改善风险分层.
- 准确的风险分类对于量身定制治疗策略至关重要 儿科ALL患者中枢神经系统参与.
研究的目的:
- 开发一种新型的儿童ALL中CNSL风险分类系统.
- 调查CNSL中克隆进化的预后意义.
- 在CNSL中识别不同的亚组,具有不同的临床结果.
主要方法:
- 对PDT-ALL-2016儿科启发队列的回顾性分析 (N=494).
- 在骨髓 (BM) 和脑脊液 (CSF) 样本上利用流细胞计 (FCM) 和下一代测序 (NGS).
- 将CNSL患者分类为非克隆进化和克隆进化亚组,基于BM和CSF之间的FCM和NGS结果的一致性.
主要成果:
- 与非CNSL患者 (62.3%) 相比,CNSL患者的5年整体存活率 (OS) (33.7%) 显著降低.
- 非克隆进化CNSL (一致的BM/CSF结果) 显示了更高的5年生存率 (48.9%),并且需要更少的腰部穿刺来实现CSF完全缓解 (CR) (1.62).
- 克隆进化CNSL (不一致的BM/CSF结果或单独的中枢神经系统复发) 具有较低的5年OS (30.2%) 并需要更多的脊椎穿刺CSFCR (4.14).
结论:
- 这项研究首次建立了基于克隆演变的CNSL风险分层.
- 确定"非克隆进化CNSL"作为标准风险子组和"克隆进化CNSL"作为高风险子组.
- 这些发现支持使用BM和CSF之间的分子和细胞遗传一致性来分类CNSL风险和指导治疗.
相关概念视频
Lineage Commitment
3.0K
Commitment is the process whereby stem cells:
3.0K
Disorders of Leukocytes
861
Leukocyte disorders can lead to either leukopenia, characterized by an abnormally low leukocyte count, or leukocytosis, marked by a very high leukocyte number.
Leukopenia may result from bone marrow disorders, autoimmune diseases, and infectious diseases. For example, conditions such as multiple myeloma and aplastic anemia can impair the bone marrow's ability to produce adequate leukocytes. Similarly, autoimmune diseases like lupus and viral infections such as HIV can prompt the immune...
Leukopenia may result from bone marrow disorders, autoimmune diseases, and infectious diseases. For example, conditions such as multiple myeloma and aplastic anemia can impair the bone marrow's ability to produce adequate leukocytes. Similarly, autoimmune diseases like lupus and viral infections such as HIV can prompt the immune...
861
Tumor Progression
6.2K
Tumor progression is a phenomenon where the pre-formed tumor acquires successive mutations to become clinically more aggressive and malignant. In the 1950s, Foulds first described the stepwise progression of cancer cells through successive stages.
Colon cancer is one of the best-documented examples of tumor progression. Early mutation in the APC gene in colon cells causes a small growth on the colon wall called a polyp. With time, this polyp grows into a benign, pre-cancerous tumor. Further...
Colon cancer is one of the best-documented examples of tumor progression. Early mutation in the APC gene in colon cells causes a small growth on the colon wall called a polyp. With time, this polyp grows into a benign, pre-cancerous tumor. Further...
6.2K
Distinctive Features of Adult Stem Cells vs Cancer Stem Cells
3.4K
A stem cell is an unspecialized cell that can divide without limit as needed and can, under specific conditions, differentiate into specialized cells.
Adult stem cells
Adult stem cells are tissue-specific; hence, they divide to develop the tissue from which they originate. One type of adult stem cell is the epithelial stem cell, which gives rise to the keratinocytes in the multiple layers of epithelial cells in the epidermis of the skin. Adult bone marrow has three distinct types of stem cells:...
Adult stem cells
Adult stem cells are tissue-specific; hence, they divide to develop the tissue from which they originate. One type of adult stem cell is the epithelial stem cell, which gives rise to the keratinocytes in the multiple layers of epithelial cells in the epidermis of the skin. Adult bone marrow has three distinct types of stem cells:...
3.4K
Cancers Originate from Somatic Mutations in a Single Cell
11.6K
Cancer arises from mutations in the critical genes that allow healthy cells to escape cell cycle regulation and acquire the ability to proliferate indefinitely. Though originating from a single mutation event in one of the originator cells, cancer progresses when the mutant cell lines continue to gain more and more mutations, and finally, become malignant. For example, chronic myelogenous leukemia (CML) develops initially as a non-lethal increase in white blood cells, which progressively...
11.6K
Differentiation of Common Myeloid Progenitor Cells
3.2K
Common myeloid progenitors (CMPs) are oligopotent cells that can differentiate into granulocytes and macrophages. Granulocytes and macrophages are essential for protecting the body against bacterial, viral, or fungal infections. They migrate from the bone marrow into the circulating blood to reach specific tissue sites where they differentiate and help in immune surveillance. However, they survive only for a few days and must be continuously made available to the organism to maintain a robust...
3.2K


