Medical researchers in China are developing a new risk score to predict leukemia relapse

Leukemia is a group of blood cancers that affects thousands of people around the world. However, with advances in medicine, several different types of leukemia can be effectively treated with donor stem cells through allogeneic stem cell transplantation (Allo-SCT). One such type of leukemia is B-cell acute lymphoblastic leukemia (B-ALL), which is caused by uncontrolled proliferation and prolonged existence of cancerous B-cells. While the Allo-SCT B-ALL can “heal” in several cases, there are also cases of failure, which are characterized by deterioration in health after a recovery period – a period medically known as relapse. Predicting this adverse outcome early on can have several medical benefits for appropriate patients and the healthcare system.

To meet this challenge, a group of medical researchers from the Beijing Key Laboratory of Hematopoetic Stem Cell Transplantation, Peking University and the Chinese Academy of Medical Sciences successfully developed an effective risk score that can accurately predict a relapse of leukemia after allo-SCT. Their results have been published as a research article in. released Chinese Medical Journal.

The comprehensive methodology of the study is explained by Dr. Xiao-Jun Huang of the Peking University Institute of Hematology, Peking University People’s Hospital, who led the study, and explains: University People’s Hospital from December 2010 to December 2015 in this retrospective study. Our aim was to evaluate the factors associated with the transplant results after Allo-SCT and to create a risk score to identify patients with different relapse rates. We performed univariate and multivariate analyzes with the Cox proportional hazards model using time-dependent variables to analyze our data. ”

As suggested by Dr. Huang noted, some of the analyzed factors associated with the allo-SCT transplant results included the transplantation of white blood cells such as neutrophils and platelets in the patients; Presence of residual cancer cells measured as minimal residual disease (MRD); Occurrence of chronic graft-versus-host disease (cGVHD); and decrease in leukemia symptoms, medically known as remission, after the procedure. The researchers then examined whether these factors could be used to determine outcomes such as 5-year cumulative relapse incidence (CIR), overall survival (OS), leukemia-free survival (LFS), and non-relapse mortality in the patients. Finally, these results were used to formulate the risk score.

In particular, among the patients screened for the various factors described above, the researchers observed that all of them achieved a neutrophil transplant and 95.4% of them achieved a platelet transplant. They also observed that 20.7% of patients had CIR, 70.4% of them overall survived, 65.6% suffered LFS, and 13.9% succumbed to non-relapse mortality.

Another statistical analysis allowed the researchers to observe clear associations between the factors analyzed and the results assessed. In this context, Dr. Huang enthusiastically: “Our analysis showed that patients with a positive MRD after transplantation who were transplanted beyond the first complete remission (? CR2) and without cGVHD had a higher CIR and poorer LFS and OS than patients without an MRD after transplantation , transplanted into CR1 and with cGVHD. ”With such obvious observations as Dr. Huang said the researchers immediately proceeded to develop their risk score.

The novel risk score found 5-year recurrence rates of 6.3%, 16.6%, 55.9% and 81.8% as 0, 1, 2 and 3, respectively. The researchers added that with increasing Risk score, the 5-year LFS and OS values ​​decreased accordingly.

Overall, the researchers hope that the risk score they have developed will serve as a guide for treating leukemia by allowing stratification of patients with different relapse risks. They also hope that this will enable better medical intervention. Indeed, the world can hope that this risk score marks a milestone in predicting relapse of leukemia.

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reference

Title of the original paper: A Risk Score System for Stratifying the Risk of Recurrence in Patients with B-Cell Acute B-Cell Leukemia After Allogeneic Stem Cell Transplantation

Diary: Chinese Medical Journal

DOI: https: //doi.Organization/10.1097 /CM9.0000000000001402

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