儿童急性淋巴细胞白血病的长期随访和预后分析  

Long-term follow-up and prognosis of children with acute lymphoblastic leukemia

作　　者：陆海燕[1] Lu Haiyan(Department of Hematology, Children＇s Hospital of Shanxi, Taiyuan 030013, China)

机构地区：[1]山西省儿童医院血液科,太原030013

出　　处：《中国实用医刊》2018年第11期43-46,共4页Chinese Journal of Practical Medicine

摘　　要：目的探究急性淋巴细胞白血病（ALL）患儿的疗效及预后影响因素。方法整理176例ALL患儿的临床资料及转归，回顾性分析其临床特征、基因特征、治疗反应、预后及预后影响因素，采用单因素分析和Log-rank检验分析其预后影响因素。结果143例患儿完成诱导治疗，完全缓解率为95.8%，5年无事件生存率为78.2%。预后单因素分析：初诊白细胞计数（WBC）≥50×109/L、发病年龄≥10岁、T细胞型、强的松反应不良、诱导15 d骨髓呈M2/3状态、33 d骨髓微小残留病灶（MRD）≥10－3、3个月骨髓MRD≥10－4、基因BCR/ABL阳性、危险度高危为不良预后因素。COX回归多因素分析显示：免疫分型、诱导15 d骨髓常规、治疗3个月骨髓MRD、危险度是独立预后因素。结论ALL患儿，尤其是低中危患者，靠化疗可取得高缓解率和长期生存，免疫分型、诱导15 d骨髓常规、3个月骨髓MRD、危险度是小儿ALL独立预后因素。ObjectiveTo analyze treatment outcome and prognostic factors of children with acute lymphoblastic leukemia （ALL）.MethodsThe clinical data and outcome of 176 pediatric ALL patients were collected, the clinical characteristics, genetic features, therapeutic response, prognosis and prognostic factors were studied retrospectively. Univariate analysis and Log-rank test were used to analyze the prognostic factors.ResultsAmong 176 patients, 143 cases got complete induction therapy, complete remission rate was 95.8%, and 5-year event free survival rate was 78.2%. Univariate analysis of prognostic factors： primary white blood cell （WBC） count ≥50×109/L, age of onset ≥10-year old, T-ALL, had adverse reaction of prednisone, bone marrow in M2/3 stage after 15 days of induction, minimal residual disease （MRD） ≥10-3 after 33 days of treatment, MRD≥10-4 after 3 months of treatment, BCR/ABL gene positive and high-risk grade were related factors of poor prognosis. Multivariate COX regression analysis showed that T-ALL, bone marrow examination after 15 days of induction, MRD after 3 months of treatment, the risk grade were independent prognostic factors.ConclusionsChildren with ALL, especially non-high-risk patients, could obtain high CR rate and long-term survival by chemotherapy. T-ALL, bone marrow examintion after 15 days of induction for bone, 3 months MRD, and risk grade were independent prognostic factors.

关 键 词：急性淋巴细胞白血病 儿童 预后因素 

分 类 号：R733.71[医药卫生—肿瘤]