儿童T细胞急淋白血病危险度特异性微小残留病分层标准研究  

Study on risk-specific minimal residual disease stratification criteria in childhood T cell acute lymphoblastic leukemia

作　　者：邓莉萍 崔蕾 李伟京 高超 赵晓曦 吴敏媛 张瑞东 李志刚 DENG Liping;CUI Lei;LI Weijing;GAO Chao;ZHAO Xiaoxi;WU Minyuan;ZHANG Ruidong;LI Zhigang(Laboratory of Hematologic Diseases,Beijing Children′s Hospital,Capital Medical University,National Center for Children′s Health,Beijing Key Laboratory of Pediatric Hematology Oncology,Key Laboratory of Major Diseases in Children,Ministry of Education,National Key Discipline of Pediatrics(Capital Medical University),Beijing 100045,China;Hematology Oncology Center,Beijing Children′s Hospital,Capital Medical University,National Center for Children′s Health,Beijing Key Laboratory of Pediatric Hematology Oncology,Key Laboratory of Major Diseases in Children,Ministry of Education,National Key Discipline of Pediatrics(Capital Medical University),Beijing 100045,China)

机构地区：[1]国家儿童医学中心,首都医科大学附属北京儿童医院,北京市儿科研究所血液疾病研究室,儿童血液病与肿瘤分子分型北京市重点实验室,儿科重大疾病研究教育部重点实验室,儿科学国家重点学科,北京100045 [2]国家儿童医学中心,首都医科大学附属北京儿童医院,北京市儿科研究所血液肿瘤中心,儿童血液病与肿瘤分子分型北京市重点实验室,儿科重大疾病研究教育部重点实验室,儿科学国家重点学科,北京100045 [3]新乡医学院第一附属医院儿科,卫辉453100

出　　处：《中国小儿血液与肿瘤杂志》2020年第2期76-81,103,共7页Journal of China Pediatric Blood and Cancer

基　　金：国家科技重大专项课题(编号:2017ZX09304029);北京市教育委员会科技发展计划一般项目(编号:KM201810025025);北京市科技计划项目(编号:Z181100001718100);北京新阳光慈善基金会助医儿童白血病研究基金项目(编号:2017002)。

摘　　要：目的探讨儿童T细胞急淋白血病(T-ALL)危险度特异性微小残留病(MRD)分层标准的预后价值。方法对于采用BCH-03方案(n=40)或CCLG-08方案(n=43)治疗的T-ALL患儿,分别在中危和高危组分析诱导治疗结束(TP1)和巩固治疗前(TP2)MRD水平与治疗效果的相关性。结果在TP1,中危组MRD≥10-3、高危组MRD≥10-2与预后差相关。在TP2,中危组MRD阳性、高危组MRD≥10-4也与预后差有关。据此,提出了新的分层标准:对中危组,MRD反应良好(MRD-GR)指TP1 MRD<10-3或TP2 MRD阴性,MRD反应差(MRD-PR)指TP1 MRD≥10-3且TP2 MRD阳性;对高危组,MRD-GR指TP1 MRD<10-2且TP2 MRD<10-4,MRD-PR指TP1 MRD≥10-2或TP2 MRD≥10-4。无论中危或高危,最终复发的患儿均为MRD-PR,10年无复发生存率分别为(64.3±12.8)%和(20.0±12.6)%(与MRD-GR比较,P值分别为0.0003和0.001)。结论对儿童T-ALL,危险度特异性MRD分层标准可能更准确地预测疗效,应在使用相同治疗方案的多中心研究中加以验证。Objective To investigate the prognostic significance of risk-specific minimal residual disease(MRD)stratification criteria in childhood T cell acute lymphoblastic leukemia(T-ALL).Methods In children with intermediate risk(IR)or high risk(HR)T-ALL treated by BCH-03(n=40)and CCLG-08(n=43)protocol,the correlation of MRD levels with treatment outcome was analyzed at the end of remission induction(TP1)and before consolidation therapy(TP2).Results At TP1,MRD≥10-3 or≥10-2 were correlated to worse treatment outcome in IR and HR respectively.At TP2,positive MRD and MRD≥10-4 also had similar prognostic significance in IR and HR patients.Subsequently,MRD good response(MRD-GR)were defined as MRD<10-3 at TP1 or negative at TP2 in IR group,and MRD<10-2 at TP1 and<10-4 at TP2 in HR group;MRD poor response(MRD-PR)were defined as MRD≥10-3 at TP1 and positive at TP2 in IR group,and MRD≥10-2 at TP1 or≥10-4 at TP2 in HR group.Both IR and HR patients who relapsed eventually were in MRD-PR groups with ten years relapse free survival of(64.3±12.8)%and(20.0±12.6)%(P=0.0003 and 0.001 respectively).Conclusions Risk-specific MRD stratification criteria may predict treatment outcome more accurately in childhood T-ALL.

关 键 词：T细胞ALL 儿童 微小残留病 分层标准 复发 

分 类 号：R73[医药卫生—肿瘤]