儿童B-急性淋巴细胞白血病治疗中微量残留病动态监测及其意义  

Prognostic value of minimal residual disease in childhood B-cell acute lymphobhlstic leukemia

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

机构地区：[1]上海交通大学医学院附属新华医院上海儿童医学中心血液肿瘤科

出　　处：《中华血液学杂志》2006年第2期120-123,共4页Chinese Journal of Hematology

基　　金：上海市重点学科建设资助项目(T0204)

摘　　要：目的评价微量残留病(MRD)监测在儿童B-急性淋巴细胞白血病(B-ALL)治疗中的预后价值。方法2001年9月1日至2004年10月31日采用ALL-XH-99方案行MRD标记筛选并监测的B-ALL患儿102例。用四色多参数流式细胞仪监测诱导治疗结束完全缓解(CR)时、髓外白血病预防性治疗前、早期强化前、维持治疗中定期强化前、维持治疗1年及2年时患儿。MRD 。结果①行筛选并监测的102例B-ALL患儿中,对诱导治疗结束获CR的86例患儿进行了MRD监测。其中MRD ≥10^(-4)的患儿20例,占23．30％;MRD<10^(-4)的患儿66例,占76．70％,其39个月无事件生存率分别为 0．00％和(83．00±9．90)％,差异有统计学意义(P<0．01)。②单因素分析显示患儿的性别、起病时年龄、白细胞计数及染色体倍体数与CR时MRD水平无关(P>0．05);而Ph染色体、诱导治疗第19天骨髓幼稚淋巴细胞比例、CR时间、ALL-XH-99危险度分类标准与其相关(P<0．05)。③多因素分析显示 CR时MRD水平具有独立的预后价值(比例风险为5．381,95％可信区间为0．004-0．624,P<0．05)。结论诱导治疗结束CR时MRD水平可用于评估早期治疗反应,是儿童B-ALL治疗中重要的预后因素之一。Objective To assess the prognostic value of minimal residual disease （MRD） in childhood B-cell acute lymphoblastic leukemia （ALL） after induction chemotherapy. Methods From September 2001 to October 2004, 102 patients with newly diagnosed B-ALL were enrolled in protocol ALL-XH-99. MRD after induction therapy, before high-dose methotrexate and early intensification as well as at 1 year and 2 year maintenance therapy was detected by muhiparameter-flow-cytometry（MP-FCM）. Results （1）The probability of 39-month event-free survival （EFS） for patients with a level of MRD 〈 10^-4, was significantly higher than for those with a higher MRD [ （83.00 ± 9.90） % vs 0.00%, P 〈 0.01 ]. （2）Univariate analysis indicated that the MRD level at achieving complete remission（CR） had no relationship with the biologic features at persentation （gender, age, white blood cells and cytogenetic abnormalities）, but did with Philadelphia chromosome, the time reaching CR, ALL-XH-99 risk group and lymphoblasts in bone marrow on day 19 after induction therapy （P 〈 0.05 ）. （3）Muhivariate analysis suggested that MRD level after the first induction course was an independent prognostic factor （hazard ratio, 5.381 ; 95 % CI 0. 004 to 0. 624 ; P 〈 0.05）. Conclusion The MRD level at achieving CR is one of important prognostic factor in the treatment of childhood B-cell ALL, and might be used to assess the early treatment response.

关 键 词：白血病 淋巴细胞 急性 儿童 微量残留病 预后因素 

分 类 号：R733.71[医药卫生—肿瘤] R699.2[医药卫生—临床医学]