Blood：肥胖白血病患者或更易患久治不愈的顽疾

  近日，刊登在国际著名杂志Blood上的一篇研究报告中，来自洛杉矶儿童医院的科学家们表示，相比患急性淋巴细胞白血病（ALL）的偏瘦青年人，肥胖ALL患者的预后或许更糟糕，为了揭示发生这一现象的原因，研究人员对肥胖的ALL患者进行研究来确定是否体重指数(BMI)会影响个体对最初化疗的反应，机体对起初化疗的反应，即对诱导治疗的反应可以通过在骨髓中白细胞不存在时进行测定，在最小残留疾病（MRD）情况下，残留的白血病细胞在显微镜下并不会看到，但其仍然可以通过敏感的方法检测到，同时这些残存的白血病细胞也是患者疾病复发和生存期的有效指示器。

  Steven Mittelman博士说道，肥胖个体患微小残留白血病的可能性是非肥胖个体的两倍以上，而诱导化疗方法也为病人的治疗提供了很好的选择，本文研究中我们揭示了，肥胖可以负面影响化疗杀灭白血病细胞的能力，从而减少个体的生存期。

  文章中研究者对198名年龄在1至21岁之间的ALL个体进行观察研究，每一位患者的体重指数都被换算成百分比，并且进行分类，85%至94%的定义为过重，超过95%的定义为肥胖，低于85%的定义为偏瘦型；大约三分之一的病人都是肥胖或者过重的状态。

  研究者发现，偏瘦病人的最小残留疾病和无残留疾病的肥胖个体具有类似的预后结果，而存在最小残留疾病的肥胖个体的预后是最差的。Hisham Abdel-Azim博士说道，加上病人在治疗后患持续性疾病的可能性，肥胖个体似乎会增加特殊的风险因子，而该风险因子也将会改变化疗方法和残留白血病细胞之间的相互作用，本文研究或为改善肥胖个体的化疗方法提供一定的帮助和参考依据。 （转化医学网360zhyx.com）

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转化医学网推荐的原文摘要：

Obesity is associated with residual leukemia following induction therapy for childhood B-precursor acute lymphoblastic leukemia
Blood DOI:10.1182/blood-2014-08-595389
Etan Orgel1, Jonathan Tucci2, Waseem Alhushki3, Jemily Malvar1, Richard Sposto4, Cecilia H. Fu1, David R. Freyer1, Hisham Abdel-Azim1, and Steven D. Mittelman2,*
Obesity is associated with poorer event-free survival (EFS) in pediatric acute lymphoblastic leukemia (ALL). Persistent minimal residual disease (MRD) in the bone marrow as measured by multidimensional flow cytometry (MDF) is a key early prognostic indicator and is strongly associated with EFS. We therefore hypothesized that obesity during induction would be associated with positive end of induction MRD (≥0.01%). We analyzed MDF of end-induction bone marrow samples from a historical cohort of 198 children newly diagnosed with B-precursor ALL (BP-ALL) and treated with Children's Oncology Group induction regimens. We assessed the influence of body mass index (BMI) on risk for positive end-induction MRD in the bone marrow. In our cohort of BP-ALL, 30 children were overweight (15.2%) and 41 obese (20.7%) at diagnosis. Independent of established predictors of treatment response, obesity during induction was associated with significantly greater risk for persistent MRD (Odds Ratio 2.57, 95% Confidence Interval 1.19-5.54, p=0.016). Obesity and overweight were associated with poorer EFS irrespective of end-induction MRD (p=0.012). Obese children with newly diagnosed BP-ALL are at increased risk for positive end-induction MRD and poorer EFS.