急性淋巴细胞白血病患儿糖皮质激素预试验的临床意义  

Clinical significance of glucocorticoid induction test in Chinese childhood acute lymphoblastic leukemia

作　　者：范俊杰[1] 柴忆欢[1] 胡绍燕[1] 何海龙[1] 赵文理[1] 王易[1] 李捷[1] 卢俊[1] 肖佩芳[1] 

机构地区：[1]苏州大学附属儿童医院血液肿瘤科,215003

出　　处：《中华儿科杂志》2013年第7期523-526,共4页Chinese Journal of Pediatrics

基　　金：国家＂十一五＂科技支撑计划项目（2007BAI04B03）

摘　　要：目的 探讨儿童急性淋巴细胞白血病进行糖皮质激素预试验的临床意义以及与预后的关系.方法 对309例急性淋巴细胞白血病患儿应用糖皮质激素预试验治疗7d,根据第8天外周血幼稚细胞动态变化分为激素敏感组（PGR组）263例及激素不敏感组（PPR组）46例,分析两组患儿临床特征及治疗转归.结果 PGR组与PPR组初诊白细胞计数分别为30.97×109/L及86.30×109/L,PGR组低于PPR组（P＜0.01）.B系白血病患儿激素敏感率高于T系患儿,分别为86.6％及60.0％ （P ＜0.05）.初诊高危、中位、标危组对激素敏感率分别为51.4％、82.7％、93.7％,不同的初诊危险度对激素敏感性各不相同（P ＜0.0125）；两组间染色体表达情况差异无统计学意义（P＞0.05）；BCR-ABL融合基因阳性者更易对激素不敏感（P＜0.05）,而MLL、TEL-AML1、E2A-PBX1融合基因阳性率两组间差异无统计学意义（P＞0.05）.治疗第15天（D15）、第33天（D33）复查骨髓,PGR组缓解率为60.5％、94.6％,PPR组缓解率为32.6％、73.3％,PGR组均高于PPR组（P均＜0.01）；D33、第12周（W12）检查微小残留病（MRD）水平,达10-4者PGR组为75.9％、85.0％,PPR组为44.7％、66.7％,两组间差异均有统计学意义（D33：P＜0.01,W12：P＜0.05）.随访结果：达持续缓解（CCR）者PGR组215例,PPR组28例,PGR组CCR率明显高于PPR组（P＜0.01）.结论 糖皮质激素预试验与多项临床特征及疗效相关,是评估儿童急性淋巴细胞白血病预后的一项重要指标.Objective Acute lymphoblastic leukemia （ALL） is the most common childhood cancer,while glucocorticoid （GC） is a critical component in multi-agent chemotherapy protocols currently used for the treatment of ALL.The purpose of this study was to investigate the relationship between the glucocorticoid induction test and the clinical features and the prognosis of Chinese childhood ALL.Method The study recruited 309 hospitalized patients （187 male and 122 female） with childhood ALL,the sex,age,initial WBC count,immunophenotype,chromosome and gene expression were recorded.After diagnosis,all patients received GC induction test for 7 days.Then they were divided into prednisone good response （PGR） group and prednisone poor response （PPR） group according to the peripheral lymphoblast count on D8.Early responses to chemotherapy and treatment outcomes of the patients in the two groups were also analyzed.Result Of the 309 patients,263 belonged to PGR group and 46 belonged to PPR group.Initial WBC count was higher in PPR group than in PGR group（86.30 × 109/L vs.30.97 × 109/L,P 〈0.01）.B lineage ALL showed more sensitive to GC than T-ALL （86.6% vs.60%,P 〈0.05）.Different initial-risk-group＇s sensitivity to GC differed from one another （high-risk：51.4%,medium-risk：82.7%,standard risk：93.7%,P 〈 0.0125）.There was no significant difference between two groups in chromosomal karyotypes （P 〉 0.05）.BCR-ABL positive ALL showed lower sensitivity to GC （P 〈 0.05）,while MLL,TEL-AML1,E2A-PBX1 positive rates in two groups were of no statistical significance （P 〉0.05）.Bone marrow was reviewed on D15 and D33,and the CR rates in PGR group were significantly higher than that in PPR group （D15：60.5% vs.32.6%,D33：94.6% vs.73.3%,P 〈0.01） ; Minimal residual disease （MRD） levels were examined on D33,W12,and both were much lower in PGR group （D33：P 〈 0.01,W12：P 〈 0.05）.Of the PGR group 215 patients （81.7%） remained continuously in complete remission （CCR）

关 键 词：白血病 淋巴样 预后 糖皮质激素类 预试验 

分 类 号：R733.71[医药卫生—肿瘤]