微量残留疾病监测预测T细胞急性淋巴细胞白血病患儿生存预后的最佳时机  

The Best Time of Minimal Residual Disease Monitoring for Predicting Survival and Prognosis in Children with T-Cell Acute Lymphoblastic Leukemia

作　　者：包鸿 李天宇[1] 吴袁涛 肖卓韬 张琳 罗凌云 BAO Hong;LI Tian-Yu;WU Yuan-Tao;XIAO Zhuo-Tao;ZHANG Lin;LUO Ling-Yun(Department of Hematology and Oncology,Children's Hospital of wuxi,Wuxi 214000,Jiangsu Province,China;Department of Oncology,The Second Affiliated Hospital of Soochow Universityy Suzhou 215004,Jiangsu Province,China;Department of Nephrology,The First Affiliated Hospital of Soochow Universityy Suzhou 215006,Jiangsu Province,China;Suzhou Department of Hematology,Children's Hospital of the University,Suzhou 215002,Jiangsu Province,China)

机构地区：[1]无锡市儿童医院血液肿瘤科,江苏无锡214000 [2]苏州大学附属第二医院肿瘤科,江苏苏州215004 [3]苏州大学附属第一医院肾内科,江苏苏州215006 [4]苏州大学附属儿童医院血液科,江苏苏州215002

出　　处：《中国实验血液学杂志》2021年第5期1471-1477,共7页Journal of Experimental Hematology

基　　金：江苏省卫生健康委2019年度医学科研立项项目(Z201943);无锡市科教强卫医学发展学基金资助项目(FZXK001)。

摘　　要：目的:探讨T细胞急性淋巴细胞白血病(T-ALL)患儿经CCLG-ALL2008方案化疗后微量残留疾病(MRD)监测预测生存预后的最佳时机。方法:回顾性总结2015年1月至2020年1月于无锡市儿童医院确诊T-ALL后接受CCLG-ALL2008方案化疗的患儿共96例,中位随访时间43.5(9-65)个月。用Kaplan-Meier生存曲线绘制总体无事件生存率(EFS)和总生存率(OS),单因素比较EFS组与复发组、OS组与死亡组的临床资料、化疗d 15、33和90 d的MRD水平,多因素Logistic回归分析筛选EFS和OS的主要危险因素,根据d 15、33和90 d的MRD水平将患者分为低、中和高风险,再次比较组间EFS和OS的差异。结果:至随访截止,96例患儿中共复发50例,46例未复发;死亡40例,存活56例。EFS为(49.5±6.3)%,OS为(61.5±5.9)%。单因素分析发现,EFS组(n=46)初始白细胞数明显低于复发组(n=50)、33和90 d的MRD水平明显降低(P<0.05);OS组(n=56)强的松反应优于死亡组(n=40),中枢神经侵犯率降低,33和90 d的MRD水平明显降低(P<0.05)。Logistic回归分析结果显示,90 d的MRD水平是EFS的主要危险因素,强的松反应、中枢神经侵犯和90 d的MRD水平是OS的主要危险因素(P <0.05)。根据d 15和33 d的MRD水平分组结果显示,组间EFS和OS无明显差异(P> 0.05),但根据90 d的MRD水平分组结果显示,高风险组EFS和OS明显低于中风险组,中风险组明显低于低风险组(P<0.05)。结论:T-ALL患儿CCLG-ALL2008方案化疗后90 d的MRD水平对预测生存预后可能是最佳时机。Objective:To investigate the optimal time of monitoring minimal residual disease(MRD)for predicting survival and prognosis in children with T-cell acute lymphoblastic leukemia(T-ALL)after treated by CCLG-ALL2008 chemotherapy.Methods:96 children with T-ALL receiving CCLG-ALL2008 chemotherapy treated in our hospital from January 2015 to January 2020 were retrospectively summarized.The follow-up time was 9.0-65.0 months,with a median of 43.5 months.Kaplan-Meier survival curve was used to detect the overall event-free survival(EFS)and overall survival(OS)of the patients.The clinical data,MRD levels after 15 d,33 d and 90 d chemotherapy between EFS group and relapse group,as well as OS group and death group were compared by using univariate analysis.Multivariate Logistic regression analysis was used to screen the main risk factors affecting EFS and OS of the patients.The patients were divided into low,moderate and high-risk according to the MRD level after 15 d,33 d and 90 d,the differences of EFS and OS between each groups were compared again.Results:By the end of follow-up,50 patients recurred and other46 patients non-recurred;40 patients died and 56 patients survived,the EFS was(49.5±6.3)%and OS was(61.5±5.9)%.Univariate analysis showed that the initial WBC count in EFS group(n=46)was significantly lower than that in relapse group(n=50),and MRD levels after 33 d and 90 d were significantly less also(P<0.05).Prednisone response in OS group(n=56)was better than that in death group(n=40),and central nerve invasion rate was lower,MRD level after 33 and 90 d were lower(P<0.05).Logistic regression analysis showed that MRD level after90 d was the main risk factor affecting EFS of the patients;prednisone reaction,central nerve invasion and MRD level after 90 d were the main risk factors affecting OS of the patients(P<0.05).There were no differences of EFS or OS between the groups according to the MRD levels after 15 and 33 d(P>0.05),however for 90 d,EFS and OS of the patients in high-risk group were significantly lower t

关 键 词：T细胞急性淋巴细胞白血病 微量残留疾病 无事件生存 总生存 儿童 

分 类 号：R733.71[医药卫生—肿瘤]