高通量药物敏感性检测在儿童复发难治性急性白血病的应用  

The application of high-throughput drug sensitivity assay on the screening salvage chemotherapy regimens for children with relapsed and refractory acute leukemia

作　　者：林丹娜[1] 张观梅 刘改英 金明[1] 张亚芥 吴莉 程明[1] 余莉华[1] 杨丽华[1] LIN Danna;ZHANG Guanmei;LIU Gaiying;JIN Ming;ZHANG Yajie;WU Li;CHENG Ming;YU Lihua;YANG Lihua(Department of Pediatric Hematology and Critical Care Medicine,Zhujiang Hospital,Southern Medical University,Guangzhou 510280,China;Department of Pediatrics,Zhuhai People′s Hospital,Zhuhai 519070,China)

机构地区：[1]南方医科大学珠江医院小儿血液科及重症医学科,广州510280 [2]珠海市人民医院儿科,珠海519070

出　　处：《中国小儿血液与肿瘤杂志》2023年第1期16-20,共5页Journal of China Pediatric Blood and Cancer

摘　　要：目的探讨高通量药物敏感性检测(HDS)技术用于筛选儿童复发难治性急性白血病(RR-AL)挽救化疗方案的可行性。方法收集2020年12月至2021年12月该院5例接受了HDS筛选的中高度敏感化疗方案治疗的RR-AL患儿临床资料,分析其缓解率、并发症及治疗结局。结果接受了HDS筛选化疗方案的5例患儿,年龄2岁~13岁,其中巩固化疗结束后微小残留病(MRD)未转阴的急性淋巴细胞白血病(ALL)2例,骨髓复发ALL 2例,骨髓复发急性髓系白血病1例。经过1~3个疗程HDS筛选方案治疗后,共4例取得缓解,其中3例MRD转阴,1例分子学MRD水平下降;另一例治疗后病情进展。治疗有效的4例RR-AL桥接了异基因造血干细胞移植(Allo-HSCT),无病生存至今。5例RR-AL患儿在挽救化疗期间,均合并不同程度感染,无1例发生治疗相关死亡。结论HDS技术用于儿童RR-AL的挽救化疗方案的筛选是可行的,为取得MRD转阴桥接Allo-HSCT创造了机会。Objective To investigate the availability of high-throughput drug sensitivity assay(HDS)on screening salvage chemotherapy regimens for children with relapsed and refractory acute leukemia(RR-AL).Methods The clinical data were retrospectively collected from 5 children with RR-AL who were diagnosed in our department from December 2020 to December 2021 and treated with medium or high sensitive chemotherapy regimens from HDS results.The rate of complete remission(CR)and comorbidities and living outcomes were analyzed.Results Five patients received HDS screening protocols,aged 2-13 years,two patients had refractory acute lymphoblastic leukemia(ALL)(with positive minimal residual disease after consolidation chemotherapy),two had relapsed ALL,and one had relapsed acute myeloid leukemia(AML).After 1-3 cycles of HDS screening protocols,four patients achieved CR(three with negative minimal residual disease(MRD)and one with a decreased molecular MRD),while the other patient encountered disease progression.Four patients who achieved CR were bridged with allogeneic hematopoietic stem cell transplantation(allo-HSCT)and all achieved a disease-free survival to date.During courses of salvage chemotherapy,all the 5 patients were complicated with infection by varying degrees,no treatment-related death.Conclusions The application of HDS on screening salvage chemotherapy regimens for children with RR-AL creates more chances to achieve negetive MRD and further,more chances to receive HSCT therapy.

关 键 词：高通量 药物敏感性 复发难治性急性白血病 儿童 

分 类 号：R733.71[医药卫生—肿瘤]