83例急性淋巴细胞白血病中枢浸润患者的临床特征及预后分析  

Analysis on clinical features and prognosis in 83 cases of acute lymphoblastic leukemia with central nervous system infiltration

作　　者：杨艳[1] 伦燕 赵婷婷[1] 李清 吴俣[1] 

机构地区：[1]四川大学华西医院血液内科,成都610041

出　　处：《重庆医学》2018年第3期311-315,共5页Chongqing medicine

摘　　要：目的探讨急性淋巴细胞白血病(ALL)伴中枢浸润患者的临床特征、治疗方案和预后。方法回顾性分析2005年1月至2015年1月在该院确诊的ALL伴中枢神经系统白血病(CNSL)患者的病历资料、实验室检查及影像学检查结果。结果共收集患者83例,其中男52例(62.65%),女31例(37.35%),中位年龄为27(15~72)岁。包括T细胞ALL 19例,B细胞ALL54例,Burkitt淋巴瘤/白血病3例,急性淋巴母细胞白血病(T/B淋巴细胞)2例,分型未明5例。83例患者中位随访时间10(1~52)个月。单因素分析结果显示初诊时高白细胞水平(WBC≥100×109/L)或1个疗程未达完全缓解(CR)的患者预后相对差,接受放疗能够改善患者生存率(P<0.05)。多因素分析中初诊时高白细胞水平是影响患者总生存(OS)期的独立预后因素(P=0.007)。结论 ALL伴CNSL的患者,其临床特点缺乏特异性,初诊时高白细胞水平、1个疗程未达CR是预后不良因素,局部放射治疗对延长患者的生存期有一定意义。Objective To investigate the clinical features,treatment regimen and prognosis of acute lymphoblastic leukemia （ALL） complicating central nervous system leukemia （CNSL）. Methods The clinical data, results of laboratory detection and imageological examination in the patients with ALL complicating CNSL in this hospital from January 2005 to January 2015 were retrospectively analyzed. Results A total of 83 cases were collected,including 52 male cases（62.65%） and 31 female cases （37.35%） with a median age of 27 （15-72） years old. Among them,19 cases were T cells ALE（T-ALL） ,54 cases were B cell ALL（B-ALL）, 3 cases were Burkitt lymphoma/leukemia,2 cases were ALL （T/B lymphocyte） and 5 cases were undefined type. The median follow-up time was 10（1-52） months. The univariate analysis results showed that the patients with high WBC count （WBC% 100× 10^9） at initial diagnosis or unreach complete remission （CR） after 1 treatment course had relatively poor prognosis. Receiving the radiotherapy could improve the patients＇ survival rate（P〈0.05）. In the multivariate analysis, high WBC count at initial diagnosis was an indePendent prognostic factor affecting the patients＇ overall survival（OS）（P=0. 007）. Conclusion The clinical features in the patients＇ with ALL complicating CNSL have poor specificity,high WBC level and unreaching CR by 1 treatment course are the poor prognosis factors,and local radiotherapy has a certain significance for prolonging the patients＇ survival period.

关 键 词：前体细胞淋巴母细胞白血病淋巴瘤 中枢神经系统白血病 疾病特征 预后 

分 类 号：R4[医药卫生—临床医学]