[1]杨秋红,罗锦霞,王妙,等.复发/难治性急性髓系白血病VEN+LDAC方案挽救治疗期间SP70/MRD变化轨迹对预后的预测价值[J].陕西医学杂志,2025,54(9):1237-1242.[doi:DOI:10.3969/j.issn.1000-7377.2025.09.015]
　YANG Qiuhong,LUO Jinxia,WANG Miao,et al.Value of SP70/MRD change trajectory during rescue treatment with VEN+LDAC regimen for relapsed/refractory acute myeloid leukemia in predicting prognosis[J].,2025,54(9):1237-1242.[doi:DOI:10.3969/j.issn.1000-7377.2025.09.015]
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复发/难治性急性髓系白血病VEN+LDAC方案挽救治疗期间SP70/MRD变化轨迹对预后的预测价值

《陕西医学杂志》[ISSN:1000-7377/CN:61-1281/TN]

卷:
54
期数:
2025年9期
页码:
1237-1242
栏目:
药物与临床
出版日期:
2025-09-05

文章信息/Info

Title:
Value of SP70/MRD change trajectory during rescue treatment with VEN+LDAC regimen for relapsed/refractory acute myeloid leukemia in predicting prognosis
作者:
杨秋红1; 罗锦霞2; 王妙3; 朱展望1
（1.株洲市中心医院血液内科，湖南 株洲 412000；2.株洲市中心医院皮肤科，湖南 株洲 412000；3.株洲市二医院耳鼻喉科，湖南 株洲 412000）
Author(s):
YANG Qiuhong1; LUO Jinxia2; WANG Miao3; ZHU Zhanwang1
(1.Department of Hematology,Zhuzhou Central Hospital,Zhuzhou 412000,China;2.Department of Dermatology,Zhuzhou Central Hospital,Zhuzhou 412000,China;3.Department of Otolaryngology,Zhuzhou Second Hospital,Zhuzhou 412000,China)
关键词:
复发/难治性急性髓系白血病; 治疗应答; 肿瘤特异蛋白70; 微小残留病灶; 变化轨迹; 预后
Keywords:
Relapsed/refractory acute myelocytic leukemia; Treatment response; Tumor-specific protein 70; Minimal residual disease; Change trajectory; Prognosis
分类号:
R 733.71
DOI:
DOI:10.3969/j.issn.1000-7377.2025.09.015
文献标志码:
A
摘要:
目的：探讨复发/难治性急性髓系白血病（AML）维奈克拉（VEN）＋低剂量阿糖胞苷（LDAC）方案挽救治疗期间肿瘤特异蛋白70（SP70）/微小残留病灶（MRD）变化轨迹对预后的预测价值。方法：选取复发/难治性AML患者206例进行前瞻性研究，均给予VEN+LDAC方案挽救治疗，于治疗前、治疗7 d后、治疗1个疗程后检测SP70/MRD水平，通过潜类别轨迹模型（LCTM）筛选出SP70/MRD不同轨迹组，采用Cox回归分析治疗期间SP70/MRD变化轨迹与预后之间的关系，采用受试者工作特征（ROC）曲线分析变化轨迹对预后的预测价值。结果：206例患者治疗7 d后、治疗1个疗程后，SP70、MRD水平呈降低趋势，SP70/MRD水平呈升高趋势（均P＜0.05）。LCTM模型筛选分析显示，潜在类别为3时的线性＋二次项模型为最优模型，筛选出T1组（高-较高组，52例，治疗期间SP70/MRD水平从高水平升高至较高水平）、T2组（中低-较高组，84例）、T3组（低-低组，70例）3个轨迹组。3个轨迹组基因突变（TP53、ASXL1）和治疗应答比较差异有统计学意义（均P＜0.05）。Cox回归分析显示，校正基因突变（TP53、ASXL1）和治疗应答后，与T1组比较，T2组、T3组预后不良风险仍分别增加2.747倍和4.697倍（均P＜0.05）。ROC曲线分析显示，治疗期间SP70/MRD呈低-低变化轨迹时预测预后不良风险的ROC曲线下面积（AUC）为0.877（95%CI：0.824~0.918），敏感度为80.77%，特异度为94.53%（P＜0.001）。结论：复发/难治性AML患者VEN＋LDAC方案挽救治疗期间不同应答SP70/MRD变化轨迹不同，且其变化轨迹与预后有关，动态监测SP70/MRD水平获取其纵向轨迹能为临床评估治疗应答和预后提供指导。
Abstract:
Objective:To investigate the value of tumor-specific protein 70 (SP70)/minimal residual disease (MRD) change trajectory during treatment with venetoclax (VEN)+low-dose cytarabine (LDAC) regimen for relapsed/refractory acute myeloid leukemia (AML) in predicting prognosis.Methods：A prospective study was conducted on 206 patients with relapsed/refractory AML,and the patients were given VEN+LDAC rescue therapy.The levels of SP70/MRD were measured before treatment,after 7 days of treatment,and after one course of treatment.The latent class trajectory model (LCTM) was used to screen different trajectory groups of SP70/MRD.The relationship between the change trajectory of SP70/MRD and prognosis during treatment was analyzed using Cox regression analysis,and the predictive value of the change trajectory for prognosis was analyzed using the receiver operating characteristic (ROC) curve.Results:After 7 days of treatment and one course of treatment,the levels of SP70 and MRD in 206 patients showed a decreasing trend,while the level of SP70/MRD showed an increasing trend (all P<0.05).The LCTM model screening analysis showed that the linear+quadratic model with a potential category of 3 was the optimal model,and 52 cases in the T1 group (high-higher group,their SP70/MRD levels increase from high to higher levels during treatment),84 cases in the T2 group (medium-low-higher group),and 70 cases in the T3 group (low-low group),representing three trajectory groups.There was a statistically significant difference in the comparison of gene mutations (TP53,ASXL1) and treatment response among the three groups (all P<0.05).Cox regression analysis showed that after adjusting for gene mutations (TP53,ASXL1) and treatment response,the risk of poor prognosis in T2 and T3 groups increased by 2.747 times and 4.697 times compared with T1 group (all P<0.05).ROC analysis revealed that during treatment,when SP70/MRD exhibited a low-low trajectory,the area under the curve (AUC) for predicting poor prognostic risk was 0.877 (95%CI:0.824-0.918),with a sensitivity of 80.77% and a specificity of 94.53% (P<0.001).Conclusion:During the rescue treatment with the VEN+LDAC regimen for relapsed/refractory AML patients,the trajectories of SP70/MRD changes were different for various responses,and these trajectories were related to prognosis.Dynamic monitoring of SP70/MRD levels to obtain their longitudinal trajectories can provide guidance for clinical assessment of treatment responses and prognosis.

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备注/Memo

备注/Memo:
湖南省科技创新计划项目（2018JJ6095）
更新日期/Last Update: 2025-09-04