儿童急性淋巴细胞白血病治疗早期白血病细胞及微量残留病监测的预后价值  

Prognostic value of both detection of lymphoblasts in the period of early treatment and minimal residual disease in childhood acute lymphoblastic leukemia

作　　者：帖利军[1] 顾龙君[1] 宋得莲[1] 蒋黎敏[1] 薛惠良[1] 汤静燕[1] 董璐[1] 潘慈[1] 陈静[1] 叶辉[1] 王耀平[1] 陈静 

机构地区：[1]上海第二医科大学附属新华医院/上海儿童医学中心血液/肿瘤科,200127

出　　处：《中华血液学杂志》2005年第1期6-9,共4页Chinese Journal of Hematology

摘　　要：目的评价诱导治疗第19天及血液学完全缓解(CR)时骨髓存在形态学可辨认的原始、幼稚淋巴细胞数及微量残留病监测在儿童急性淋巴细胞白血病(ALL)治疗中的预后价值。方法以1998年1月1日至2003年5月31日进入ALLXH99方案的193例新诊治ALL患儿为研究对象。联合化疗第19天及诱导缓解治疗结束时行骨髓形态学检查以及血液学CR时用四色多参数流式细胞仪监测微量残留病。结果①诱导治疗第19天骨髓原始、幼稚淋巴细胞≥0.050与<0.050的患儿5年无事件生存(EFS)率分别为(42.59±14.28)%和(74.24±6.67)%,差异有统计学意义(P<0.01);②诱导缓解治疗结束达血液学CR时骨髓存在形态学可识别的原始、幼稚淋巴细胞与此时无形态学可辨认的原始、幼稚淋巴细胞患儿5年EFS率分别为(63.47±9.23)%和(76.41±6.09)%,差异有统计学意义(P<0.05);③诱导缓解治疗结束血液学CR时微量残留白血病细胞≥10-4与<10-4的患儿骨髓原始、幼稚淋巴细胞数比例的差异无统计学意义(P>0.05);诱导缓解治疗结束血液学CR时微量残留白血病细胞≥10-4与<10-4的患儿22个月EFS率分别为(23.81±20.26)%和(94.44±5.40)%,差异有统计学意义(P=0.001)。结论诱导治疗第19天骨髓原始、幼稚细胞数≥0.050在儿童ALL治疗中具有独立的预后价值;诱导治疗结束血液学缓解时骨髓存在可辨认的原始、幼稚淋巴细胞及微量残留白血病细胞≥10“在儿童ALL治疗中有预后价值,可据此修正化疗方案。Objective To assess the prognostic value of both morphological persistent disease on day 19, on complete remission (CR) and minimal residual disease (MRD) in the bone marrow (BM) after multiagent remission induction therapy. Methods From January 1998 to May 2003, 193 patients with newly diagnosed ALL were enrolled on protocol of ALL-XH-99. BM blast counts on day 19 and on CR after induction therapy were examined. BM MRD at the end of induction therapy was detected by MP-FCM. Results ①The probability of 5-year event-free survival (pEFS) was significantly worse for patients with ≥0.050 BM lymphoblasts on day 19 than that with <0.050 BM lymphoblasts [(42.59±14.28)% vs (74.24±6.67)%,~P<0.001 ]. ②The 5-year pEFS was significantly worse for patients with a low percentage of lymphoblasts (<0.050) in BM on CR as compared to those with no morphological persistent lymphoblasts [(63.47±~9.23 )% vs (76.41±6.09)%, P<0.05]. ③No significant difference was found in BM lymphoblasts between patients with MRD (≥10^-4 of nucleated bone marrow cells) and those without MRD (<10^-4 ) at the end of induction therapy (P>0.05). The 22-month pEFS was significantly worse for patients with MRD as compared with those without MRD on CR [(23.81±20.26)% vs (94.44±5.40)%, P=0.001]. Conclusions BM lymphoblast ≥0.050 on day 19 after induction therapy is an independent prognostic factor for childhood ALL; low percentage of lymphoblasts and minimal residual disease in BM on remission also do it. Patients with ≥ 0.050 lymphoblast in BM on day 19 or with MRD ≥10^-4 at the end of induction therapy should receive altered and more intentive chemotherapy.

关 键 词：诱导治疗 骨髓 预后价值 血液学 微量残留病 缓解 淋巴细胞 辨认 存在形态 生存 

分 类 号：R733.7[医药卫生—肿瘤]