儿童急性淋巴细胞白血病完全缓解后骨髓幼稚淋巴细胞比例升高分析  

Analysis of the increase of bone marrow prolymphocytes after complete remission in children with acute lymphoblastic leukemia

作　　者：陈珍珠[1] 张丽娜[1] 魏旭东[1] 

机构地区：[1]郑州大学附属肿瘤医院河南省肿瘤医院血液科,450008

出　　处：《白血病．淋巴瘤》2013年第12期736-738,741,共4页Journal of Leukemia & Lymphoma

基　　金：国家自然科学基金（81170520）;国家自然科学基金（81000921）;河南省卫生厅科研课题（2011010014）

摘　　要：目的 探讨儿童急性淋巴细胞白血病（ALL）完全缓解（CR）后骨髓幼稚淋巴细胞比例升高（5％～15％）的临床意义及对预后的影响.方法 回顾性分析ALL CR后幼稚淋巴细胞增多患儿的临床资料,按骨髓幼稚淋巴细胞比例分为≤5％组（阴性对照组）,＞5％且≤10％组,＞10％且≤15％组,分析各组ALL复发情况.结果 ALL患儿CR后治疗期间出现骨髓幼稚淋巴细胞比例增高占40.54％（30/74）,其中骨髓幼稚淋巴细胞比例＞5％且≤10％时复发率为21.05 ％（4/19）,与阴性对照组的复发率15.91％（7／44）比较差异无统计学意义（P=0.895）;骨髓幼稚淋巴细胞比例＞10％且≤15％时复发率为54.54 ％（6／11）,与阴性对照组比较差异有统计学意义（P=0.014）.儿童T-ALL与B-ALL出现骨髓幼稚淋巴细胞比例升高所占比例差异无统计学意义（P=0.078）.结论 儿童ALL CR后治疗阶段骨髓幼稚淋巴细胞轻度（＞5％且≤10％）升高可能是骨髓正常的B系淋巴细胞反应性增生的结果,预后相对良好;而骨髓幼稚淋巴细胞比例＞10％且≤15％时,这些幼稚细胞极可能是白血病细胞,提示预后不良.Objective To investigate the clinical significance of bone marrow prolymphocytes increasing range from 5 ％ to 15 ％ after complete remission （CR） in children with acute lymphoblastic leukemia provide a prognosis index.Methods The cases of the children with acute lymphoblastic leukemia were analyzed retrospectively.They were divided into three groups,namely A group （N ≤ 5 ％）,B group （5 ％ ＜ N ≤ 10 ％）,C group （10 ％ ＜ N ≤ 15 ％） according to the bone marrow lymphoblast percentage,and their relapse rates were analysed.Results After the CR,the appearance of bone marrow prolymphocytes slightly increased in children with acute lymphoblastic leukemia accounted for 40.54 ％ （30/74）.When the bone marrow prolymphocytes increased to 5 ％＜ N≤ 10 ％,the difference of relapse rates [21.05 ％ （4/19）] had no statistically significant compared with the negative control group [15.91％ （7/44）] （P =0.895）,when they increased to 10 ％ ＜ N ≤ 15 ％,the difference of relapse rates [54.54 ％ （6/11）] had statistically significant compared with the negative control group （P =0.014）.The difference of incidence rates of this slightly increasing between children＇ s B-ALL and T-ALL had no statistically significant （P =0.078）.Conclusions The bone marrow prolymphocytes increase slightly （5 ％ ＜ N ≤ 10 ％） after CR in children with acute lymphoblastic leukemia might be the normal bone marrow B-lineage lymphocytes＇ reactive hyperplasia and the prognosis is relatively well.When the bone marrow prolymphocytes increase to 10 ％ ＜ N≤ 15 ％,these prolymphocytes are most likely to be leukemia cells and indicate the possibility of relapse.

关 键 词：白血病 淋巴细胞 急性 儿童 完全缓解 幼稚淋巴细胞 复发 

分 类 号：R733.7[医药卫生—肿瘤] R733.71[医药卫生—临床医学]