儿童急性B前体淋巴细胞白血病CD20表达与临床特征及预后的相关性研究  

Expression of CD20 in B-cell Precursor Acute Lymphoblastic Leukemia and Its Correlation with Clinical Outcomes

作　　者：陈晓曦[1] 袁粒星[2] 张鸽[3] 万朝敏[1] 霍婉莹 唐雪[1] 艾媛[1] 万智[1] 朱易萍[1] 高举[1] 

机构地区：[1]四川大学华西第二医院儿科,成都610041 [2]四川大学华西第二医院公共实验室,成都610041 [3]四川大学华西第二医院临床检验科,成都610041

出　　处：《四川大学学报（医学版）》2014年第4期658-663,共6页Journal of Sichuan University(Medical Sciences)

基　　金：国家科技部"十一.五"科技支撑项目(No.2007BAI04B03)资助

摘　　要：目的探讨CD20表达与儿童急性B前体淋巴细胞白血病(BCP-ALL)临床特征和预后的关系。方法研究对象为我院2009年1月至2013年5月收治的271例初诊儿童BCP-ALL,统一按中国儿童白血病协作组ALL 2008方案规范化分型治疗并长期随访。统计分析CD20阳性(CD20+BCP)和CD20阴性(CD20-BCP)ALL的临床特征、早期治疗反应和预后情况。结果 CD20+BCP占本组BCP-ALL的45.76%(124例)。CD20+BCP与CD20-BCP在性别构成比、初诊中位年龄、初诊外周血白细胞中位计数、泼尼松不敏感比例和临床危险度病例分布的差异均无统计学意义(P均>0.05)。CD20+BCP和CD20-BCP组中≥10岁的病例分别占25.81%和14.29%(P=0.017),pro-B和pre-B病例比例分别为43.55%、59.86%和56.45%、40.14%(P=0.007),BCR-ABL阳性病例比例分别为12.20%和4.86%(P=0.03),TEL-AML1阳性病例比例分别为6.50%和18.06%(P=0.005)。两组患儿诱导化疗第15d和第33d骨髓完全缓解率分别为77.50%(93/120)和74.13%(106/143),95.04%(115/121)和95.83%(138/144)(P均>0.05),4年无事件生存(EFS)率分别为78.00%±4.96%和79.05%±5.40%,4年总生存(OS)率分别为83.01%±6.13%和93.64%±2.46%(P均>0.05)。结论 CD20阳性表达与儿童BCPALL预后无明确相关性,尚不能作为判断儿童BCP-ALL不良预后的指标。CD20靶向免疫治疗在儿童BCP-ALL的应用尚需深入研究。Objective To determine whether expression of CD20is associated with clinical outcomes of childhood B-cell precursor acute lymphoblastic leukemia（BCP-ALL）.Methods 271newly diagnosed childhood BCP-ALL during January 2009to May 2013were enrolled in this study.The patients were treated in line with the Chinese Childhood Leukemia Group ALL 2008protocol（CCLG-ALL 2008）.The clinical feature,early therapeutic response and clinical outcomes of the patients with a CD20positive（CD20＋BCP）expression were compared with those with a CD20negative（CD20-BCP）expression.Results CD20＋BCP accounted for 45.76%（124cases）of all participants.There were no significant differences between CD20＋BCP and CD20-BCP patients in gender distribution,age,WBC counts when diagnosis was made,proportion of prednisone poor responders,and distribution of risk categories（P＆gt;0.05）.Patients of 10years or older comprised 25.81% and 14.29% of CD20＋BCP and CD20-BCP patients,respectively（P=0.017）.Pro-B and pre-B cases accounted for 43.55% and 59.86% of CD20＋BCP patients respectively,compared with 56.45and 40.14%in CD20-BCP patients（P=0.007）.CD20＋BCP patients had 12.20% Philadelphia positive ALL and 6.50% BCP-ALL with TEL-AML1fusion gene,compared with 4.86%（P=0.03）and 18.06%（P=0.005）in those of CD20-BCP.No significant differences were found between the two groups of patients in 15-day（77.50%vs.74.13%,P=0.525）and 33-day（95.04%vs.95.83%,P=0.757）complete remission rates. No significant differences（P＆gt;0.05）were found in predicted 4-year event-free survival〔EFS（78.00%±4.96%）vs.（79.05%±5.40%）〕and predicted 4-year overall survival〔OS（83.01% ±6.13%）vs.（93.64% ±2.46%）〕between the two groups of patients either.Conclusion CD20positivity was not found to be associated with worse prognosis of children with BCP-ALL.More studies are needed to validate the correlation between CD20and unfavorable outcomes in BCP-ALL.

关 键 词：B前体细胞急性淋巴细胞白血病 CD20 临床特征 预后 儿童 

分 类 号：R733.71[医药卫生—肿瘤]