急性B淋巴细胞白血病诱导化疗阶段骨髓检查的预后价值  

Prognostic significance of bone marrow examination during induction chemotherapy for B acute lymphoblastic leukemia

作　　者：贾月萍[1] 黄山雅美[1] 刘桂兰[1] 张乐萍[1] 陆爱东[1] 王彬[1] 

机构地区：[1]北京大学人民医院儿科,100044

出　　处：《中华实用儿科临床杂志》2014年第3期215-218,共4页Chinese Journal of Applied Clinical Pediatrics

摘　　要：目的 探讨儿童急性B淋巴细胞白血病诱导化疗阶段不同时间点、不同方法骨髓检查对预后的预测价值.方法 以2004年2月至2013年1月收住北京大学人民医院的268例初治儿童急性B淋巴细胞白血病患儿为研究对象,根据诱导化疗第8天、第15天骨髓形态学不同缓解情况分为M1、M2、M3 3组,比较组间的预后.根据骨髓微小残留病（MRD）预后判断的不同临界值将诱导化疗第15天、诱导化疗结束后MRD不同水平的患儿分为高于临界值和低于临界值2组,比较组间的预后.结果 诱导化疗第8天骨髓形态学缓解状态为M1、M2、M3的各组间总生存率差异无统计学意义（P =0.372）,无事件生存率各组间亦差异无统计学意义（P=0.393）;诱导化疗第15天骨髓形态学缓解状态为M1、M2、M3的各组间总生存率无显著性差异（P=0.050）,无事件生存率差异亦无统计学意义（P=0.324）.诱导化疗第15天MRD＞ 10.00％的患儿其3年总生存率低于MRD≤10.00％的患儿,且差异具有统计学意义（P =0.022）,而二者的无事件生存率差异无统计学意义（P=0.191）.诱导化疗结束后MRD以0.01％、0.10％、1.00％水平分别作为界值时,低于临界值组其总生存率均高于临界组,其差异具有统计学意义（P =0.018、0.006、0.002）,同样,低于临界组其无事件生存率亦高于临界值较高的组,且差异均有统计学意义（P =0.002、0.000、0.000）.结论 诱导化疗第8天及第15天的骨髓形态学缓解状态无预后意义.诱导化疗第15天MRD以10.00％作为临界值有预后意义.诱导化疗结束后的MRD应以0.01％水平作为判断预后的界值.Objective To explore the prognostic significance of bone marrow examination at different time points by using different methods during induction therapy.Methods From Feb.2004 to Jan.2013,268 newly diagnosed （B acute lymphoblastic leukemia,B-ALL） pediatric patients in Peking University People＇s Hospital,were enrolled for the study.In this study,the overall survival （OS） ratio and event-free survival（EFS） ratio of patients with different bone marrow morphology on day 8 and day 15 were analyzed.Based on different cut off value of minimal residual disease （MRD） on day 15 and end-of-induction,the OS ratio and EFS ratio of the higher patients and the lower patients were compared.Results Patients with M1,M2 or M3 marrows on day 8 had no significant difference in OS ratio （P =0.372） or EFS ratio （P =0.393）.When it came to day 15,patients with M1,M2 or M3 marrows had no significant difference in OS ratio （P =0.050） or EFS ratio （P =0.324）.Patients with MRD 〉 10.00% on day 15 had lower OS ratio than those with MRD ≤ 10.00%,and it had significant difference（P =0.022）.But there was no significant difference in EFS ratio （P =0.191）.As for MRD on the end-of-induction,when using the MRD level of 0.0l %,0.10%,1.00% as cut-off values,the lower group of end-of-induction MRD was significantly associated with a higher probability of OS ratio and it had significant differences（P =0.018,0.006,0.002）,and it showed the same results at EFS ratio （P =0.002,0.000,0.000）.Conclusions The bone marrow morphology on day 8 and day 15 during induction therapy had no prognostic significance.The MRD of day 15 had prognostic significance when using 10.00% as the cut off value.The critical value of MRD on the end-of-induction MRD should be 0.01% for the prognosis.

关 键 词：白血病 淋巴细胞 B细胞 急性 流式细胞术 微小残留病 预后 

分 类 号：R733.71[医药卫生—肿瘤]