儿童急性淋巴细胞白血病早期治疗反应对预后的预测价值  

Value of early treatment response to assess prognosis of children with acute lymphoblastic leukemia

作　　者：李红[1] 邵静波[1] 朱嘉莳[1] 张娜[1] 陈凯[1] 王真 邹冰 夏敏[1] 蒋慧[1] LI Hong;SHAO Jingbo;ZHU Jiashi;ZHANG Na;CHEN Kai;WANG Zhen;ZOU Bing;XIA Min;JIANG Hui(Department of Hematology and Oncology,Shanghai Children’s Hospital,Shanghai Jiao Tong University,Shanghai 200040,China)

机构地区：[1]上海交通大学附属儿童医院血液肿瘤科,上海200040

出　　处：《临床儿科杂志》2021年第8期600-604,共5页Journal of Clinical Pediatrics

基　　金：上海市科学技术委员会课题(No.18ZR1431200)。

摘　　要：目的探讨CCCG-2015方案治疗儿童急性淋巴细胞白血病(ALL)早期治疗反应评估对预后的预测价值。方法回顾2015年4月至2019年12月以CCCG-2015方案规范治疗的220例初诊ALL患儿的临床资料,分析诱导治疗第19、46天骨髓细胞学及微小残留病(MRD)监测评估早期治疗反应。结果220例患儿中,男128例、女92例;中位年龄5.1岁;中位随访时间45个月。诱导缓解率97.7%,长期生存率94.6%,病死率5.4%,复发率6.8%。5年无事件生存(EFS)率(87.5±2.6)%,5年总生存(OS)率(92.7±2.2)%,5年累积复发率(9.4±2.4)%,中位复发时间为32(9~34)个月。低、中、高危组5年EFS差异有统计学意义(P<0.05)。诱导第19天,MRD阴性和阳性组的5年EFS率差异有统计学意义(P<0.05);MRD阳性组中,MRD 0.01%~0.099%、0.1%~0.99%、≥1%的5年EFS率差异有统计学意义(P<0.005)。诱导第46天,MRD阴性和阳性组的5年EFS率差异有统计学意义(P<0.001)。COX回归分析发现,第19天MRD≥1%(HR=7.04,95%CI:2.84~17.46)和第46天MRD≥0.01%(HR=1.67,95%CI:1.17~2.37)是影响EFS的独立危险因素。结论诱导治疗第19天MRD<0.01%患儿复发率低,第19天MRD≥1%和第46天MRD≥0.01%患儿预后差。Objective To retrospectively analyze the value of early treatment response to assess prognosis of children with acute lymphoblastic leukemia(ALL).Methods Two hundred and twenty newly diagnosed ALL patients from April 2015 to December 2019 were included in this study.CCCG-ALL 2015 regime was given to these patients.Bone marrow cytology and minimal residual disease were detected to evaluate the early treatment response on the Day 19 and Day 46 after induction treatment.Results A total of 92 females and 128 males were enrolled in this study.The median age was 5.1 years,and the median follow-up time was 45 months.The induced remission rate was 97.7%,the long-term survival rate was 94.6%,the mortality rate was 5.4%,and the recurrence rate was 6.8%.The 5-year cumulative recurrence rate was(9.4±2.4)%,and the median recurrence time was 32 months.The 5-year EFS was(87.5±2.6)%,and the 5-year OS was(92.7±2.2)%.The difference among three groups(low-risk group,medium risk group and high-risk group)was statistically significant(P<0.05).The 5-year EFS rate of MRD-negative and positive groups on day 19 of induced therapy were(94.4±3.5)%and(82.5±3.9)%,respectively,the differences were statistically significant(P<0.05).In the MRD positive group,differences among the 5-year EFS rate of MRD 0.01%~0.099%,0.1%~0.99%,and≥1%groups were(93.5±3.8)%、(80.9±7.1)%and(64.1±10.3)%respectively,which showed statistical significance(P<0.005).The 5-year EFS rate in the MRD negative and positive groups on day 46 of induced therapy were(92.0±2.7)%and(55.6±11.7)%,respectively,and the difference was statistically significant(P<0.001).Multivariate analysis showed that MRD≥1%on day 19(HR=7.04,95%CI:2.84-17.46)and MRD≥0.01%on day 46(HR=1.67,95%CI:1.17-2.37)were independent risk factors for the prognosis of EFS.Conclusion The overall efficacy of acute lymphoblastic leukemia in children was satisfied,with high induction remission rate,and the recurrence rate of the children with D19 MRD<0.01%was low.MRD≥1%on Day 19 and MRD≥0.01%on Day

关 键 词：急性淋巴细胞白血病 无事件生存 预后 儿童 

分 类 号：R733.71[医药卫生—肿瘤]