Tag 1 A100/B54 Philadelphia-Chromosom

[Kandra]

Es ist ohne Frage ein negativer Prognosefaktor, aber eine "sehr ungünstige Prognose" sind Remissionsraten von über 80% ganz bestimmt nicht!

Vor den TKI war die Prognose extrem ungünstig das ist richtig, aber seit deren Einführung eben nicht mehr.

Wo muss man den Brief hinschicken für Anfechtungen?

Bei Erwachsenen liegt die Remissionsrate bei 20% und die Prognose wird durch die Translokation nochmal deutlich schlechter

[freak1]

Bei Erwachsenen liegt die Remissionsrate bei 20% und die Prognose wird durch die Translokation nochmal deutlich schlechter

Das ist eben nicht mehr der Fall!

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4349266/

Ph-positive (Ph+) ALL patients often present with an aggressive leukemia that is resistant to standard therapies resulting in high relapse rates. In the era of pre-tyrosine kinase inhibitors (TKIs), Ph+ ALL patients who were treated with conventional chemotherapy showed a long-term survival rate of only 10%.3–6 Upon standard chemotherapy, disease-free survival (DFS) was found to be 25%–30% in children7 and less than 20% in adults.3–6

Dank der TKI ist die Prognose erheblich verbessert worden:

The prognosis of Ph+ ALL patients has dramatically improved upon the approval of a 1st-generation BCR–ABL tyrosine kinase inhibitor (TKI), imatinib mesylate, as first-line treatment. Although TKI monotherapy may lead to CR rates of 90%–100% with a remarkable low toxicity profile even in older patients,11–12 combining TKI treatment with standard chemotherapy has led to an overall higher long-term DFS in both adults6,13–22 and children.23,24 The use of TKIs as front-line therapy of Ph+ ALL has led to improved outcome not only because of a higher number of patients achieving CR, but also due to a lower early death rate and decreased disease recurrence. As a result, an increasingly higher number of Ph+ ALL patients are now becoming eligible for SCT. In this regard, imatinib-based induction and consolidation regimens followed by matched related or unrelated allogeneic SCT (allo-SCT) in CR1 (whenever possible according to patient age and drug intolerance) have been shown to be highly effective against Ph+ ALL.25

The authors concluded that early post-transplant imatinib can effectively prevent molecular occurrence and, as a consequence, subsequent hematologic relapse, resulting in excellent remission duration (83% at 5 years) and survival (77% at 5 years).

In conclusion, the use of TKIs has significantly improved the outcome of Ph+ ALL undergoing SCT. Thus, it is likely that this scenario will be further improved by the use of other innovative biological drugs such as the T-cell engaging bispecific antibody blinatumomab. This molecule has been shown to be highly effective in inducing durable remission in refractory/resistant Ph+ ALL in both adults41 and children.42

März 2015 publiziert, also mMn definitiv relevant für unser Examen.

[Kandra]

Na dann schreib ans IMPP

[SimonM12345]

Was ist denn mit Antwort E?
Ein Genprodukt ist doch ein Protein. Das kann man mit einer PCR nicht nachweisen. Also ist doch diese Antwort auch falsch, oder? Proteine werden mit einem Western Blot zb nachgewiesen