泼尼松诱导试验评估儿童急性淋巴细胞白血病预后  

Prognostic value of response to prednisone in childhood acute lymphoblastic leukemia

作　　者：帖利军[1] 顾龙君[1] 宋得莲[1] 薛惠良[1] 汤静燕[1] 邹佳音[1] 陈静[1,1] 董璐[1] 潘慈[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,上海200127

出　　处：《中国当代儿科杂志》2005年第3期218-221,共4页Chinese Journal of Contemporary Pediatrics

摘　　要：目的探讨泼尼松诱导试验评估儿童急性淋巴细胞白血病(ALL)预后的价值。方法126例ALL初治患儿按ALLXH99治疗方案行泼尼松诱导试验,口服泼尼松(60mg/m2)7d和氨甲蝶蛉加阿糖胞苷鞘内注射1次后外周血涂片计数幼稚淋巴细胞数。若幼稚淋巴细胞数<1000/μL,为泼尼松反应良好;如幼稚淋巴细胞数≥1000/μL,为泼尼松反应不良。生存分析采用KaplanMeier方法;各组生存的比较采用logrank检验;各生物学特征的比较采用χ2检验或Fisher确切概率法(双尾)。结果110例患儿表现为泼尼松反应良好,16例患儿表现为泼尼松反应不良;5年无事件生存率(pEFS)分别为73%±5%与48%±13%,差异有统计学意义(P=0.0021)。结论泼尼松诱导试验简单,易操作,可方便地评估早期治疗反应。Objective The objective of this study was to assess the prognostic value of response to prednisone in children with acute lymphoblastic leukemia (ALL). Methods One hundred and twenty-six children with newly diagnosed ALL were enrolled in the protocol of ALL-XH-90. A prednisone good response (PGR) was defined as a blast count of less than 1 000/μL and a prednisone poor response (PPR) as a blast count of at least 1 000/μL in peripheral smears, after 7 days of oral prednisone (60 mg/m^2) and one intrathecal injection of methotrexate along with cytosine arabinoside. The probability of event-free survival (pEFS) was estimated by Kaplan-Meier analysis and the differences in pEFS between groups were assessed by the log-rank test. Differences in the biologic characteristics between groups were compared by Chi-square analysis or Fisher exact test (two-tail). Results One hundred and ten patients had PGR and 16 had PPR. The 5-year pEFS was significantly worse for patients with PPR compared with those with PGR (48%±13% vs 73%±5%, P= 0.0021). Conclusions Response to prednisone is a simple, practical and prognostic factor in childhood ALL.

关 键 词：泼尼松 淋巴细胞白血病 急性 儿童 预后 

分 类 号：R733.7[医药卫生—肿瘤]