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(MRD3)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 MRD3 and IKZF1 gene status,we categorized adult patients with B-ALL into the low-risk(MRD3-negative and IKZF1 gene deletion-negative)and high-risk(MRD3-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.
NETL
NSTL
维普
万方数据
