成人急性淋巴细胞白血病复发因素分析及风险度评价  

Analysis of relapse factors and risk assessment of adult acute lymphoblastic leukemia

作　　者：陈培翠 王婷玉 邹德慧 邱录贵 张翠仙[1] 张耀[1] 刘桂芬[1] 罗天娥[1] 

机构地区：[1]山西医科大学流行病与卫生统计学系,太原030001 [2]中国医学科学院、北京协和医学院血液学研究所、血液病医院淋巴瘤诊疗中心

出　　处：《中华血液学杂志》2013年第12期1050-1054,共5页Chinese Journal of Hematology

基　　金：国家自然科学基金（81172774）;国家青年科学基金（81001294）

摘　　要：目的探讨影响成人急性淋巴细胞白血病（ALL）患者复发的因素，建立预后指数（PI）的计算模型，为改进成人ALL防治策略提供依据。方法收集2008年8月至2011年11月中国医学科学院血液病医院收治的104例成人ALL患者资料，采用哑变量分层COX回归构建预测模型，生存率的估计采用分层Kaplan—Meier法；生存率的比较采用Log．rank检验。并计算个体PI值，然后按其分组来估计患者期望生存率。结果成人ALL患者中位生存时间为22．00个月（95％CI17．00～27．00个月）；COX回归分析表明：设治疗方式为哑变量，分层结果显示化疗组成人B．ALL患者复发风险比自体移植组高（脚值为2．052，95％C10．877-4．799，P=0．007）；初诊血红蛋白含量小于100gm（艘值为0．186，95％a0．068～0．512，P=0．001）、合并中枢神经系统白血病（CNSL）（RR值为7．767，95％CI2．951～20．433，P=0．001）、巩固化疗疗程数在3个以下（RR值为0．445，95％C10．211-0．940，P=0．034）和Ph染色体阳性（RR值为2．771，95％CI1．353～5．674，P=0．005）是影响成人B—ALL患者复发的危险因素。根据PI值分组，以PI=0．58为基准，可预测患者生存概率。结论初诊血红蛋白含量小于100g／L、合并CNSL、巩固化疗疗程数在3个以下及Ph染色体阳性是影响成人B—ALL患者复发的因素；利用PI值分组预测患者生存概率可为成人ALL患者的临床个体化治疗及预后评价提供参考。Objective To explore the risk factors of acute lymphoblastic leukemia （ALL） recurrence in adult patients and establish a prognosis index （PI） calculation model in order to improve the prevention strategy of ALL in adults. Methods 104 adult ALL patients from Blood Diseases Hospital ＆ Chinese Academy of Medical Sciences between August 2008 and November 2011 were enrolled. COX proportional hazards regression stratified by Dummy variable was used to set up the prediction model; Kaplan-Meier method and Log-rank test were used to estimate and compare the survival. After calculated individual PI value, patients＇ expected survival should be estimated by groups. Results The overall median survival of adult ALL patients was 22.00 months （95% CI 17.00-27.00）. COX regression analysis showed that chemotherapy group patients had a higher risk of recurrence than of ASCT group while setting treatment as the dummy variable （RR=2.052, 95%CI 0.877-4.799, P=0.007）. Stratified Analysis showed that the risk factors of B-ALL recurrence in adult patients included HGB 〈100 g/L （RR=0.186, 95% CI 0.068-0.512, P=0.001）, CNSL （RR=7.767, 95% CI 2.951-20.433, P=0.001）, number of consolidation chemotherapy〈3 （RR=0.445,95% CI 0.211-0.940, P=-0.034） and Ph chromosome positive （RR=2.771,95% CI 1.353-5.674, P=0.005） . Grouped by the PI value, the expected survival of each individual patient could be estimated as PI= 0.58 base. Conclusion HGB, CNSL, number of consolidation chemotherapy and Ph chromosome were independent risk factors of B-ALL recurrence in adult patients. PI value could predict the survival of adult ALL patients and provide reference for individual therapy and prognostic evaluation.

关 键 词：白血病 淋巴样 复发 预后 危险性评估 

分 类 号：R733.71[医药卫生—肿瘤]