无预后标志性基因的急性B淋巴细胞白血病患儿随访10年复发因素的分析  

The Factors Affecting Relapse in Pediatric B-cell Acute Lymphoblastic Leukemia Patients without Prognostic Fusion Genes Following Up for 10 years

作　　者：蒋梦影 高伟 高静[1] 凌婧[1] 潘健[1] 肖佩芳[1] 卢俊[1] 何海龙[1] 王易[1] 李捷[1] 李建琴[1] 柴忆欢[1] 孙伊娜[1] 胡绍燕[1] JIANG Meng-Ying;GAO Wei;GAO Jing;LING Jing;PAN Jian;XIAO Pei-Fang;LU Jun;HEHai-Long;WANG Yi;LI Jie;LI JIAN-Qin;CHAI Yi-Huan;SUN Yi-Na;HU Shao-Yan(Department of Hematology,Children's Hospital of Soochow University,Suzhou 215025,Jiangsu Province,China)

机构地区：[1]苏州大学附属儿童医院血液科,江苏苏州215025

出　　处：《中国实验血液学杂志》2022年第1期12-17,共6页Journal of Experimental Hematology

基　　金：江苏省创新团队资助课题(CXTDA2017014);江苏省重点课题(BE2017658,BE2017659,BK20180053);苏州市科技局资助课题(SS201809,BE2017659)。

摘　　要：目的:通过分析CCLG-ALL 2008方案治疗无预后标志性融合基因的急性B淋巴细胞白血病(B-ALL)患儿的疗效,并分析影响复发的相关因素。方法:回顾性分析239例于2008年3月至2012年12月在苏州大学附属儿童医院诊断为B-ALL、多重RT-PCR未检测到预后标志性融合基因,且接受CCLG-ALL 2008方案化疗的患儿,随防到2019年8月31日,中位随访时间92(0-136)个月。Kaplan-Meier分析无复发生存时间(RFS),COX多因素回归分析复发相关的独立因素。结果:239例患儿中男性140例,女性99例,男女比例1.41∶1,中位诊断年龄4.4岁,初诊白细胞中位数是4.98×10^(9)/L,复发77例,非复发162例,失访16例,死亡72例。复发率和死亡率分别为32.22%和30.1%,其中45例死于复发(占总死亡人数62.5%)。对复发危险因素进行单因素分析,发现初诊年龄≥6岁、初诊白细胞计数>100×10^(9)/L、d15骨髓原始细胞≥25%、第12周骨髓微小残留病(MRD)>10^(-4)以及最终危险度为高危是影响复发的主要因素(P<0.05)。多因素COX回归分析显示,年龄≥6岁、初诊白细胞数>100×10^(9)/L、第12周骨髓MRD>10^(-4)是复发的独立危险因素。结论:年龄、初诊白细胞计数、第12周骨髓MRD与无预后标志性融合基因B-ALL患儿复发相关,在临床工作中可作为评估患儿复发风险的预后指标。Objective:To analyze the efficacy of children with B-cell acute lymphoblastic leukemia(B-ALL)without prognostic fusion genes treated by CCLG-ALL 2008,and investigate the related factors affecting the recurrence of the patients.Methods:B-ALL patients without prognostic fusion genes treated by the protocol of CCLG-ALL 2008 in our hospital from March 2008 to December 2012 were retrospectively analyzed.Follow-up time was ended in August 31,2019.The median follow-up time was 92 months(range 0-136 months).Kaplan-Meter was used to detect the RFS,and COX multivariate regression analysis was employed to identify the independent factors affecting the recurrence of the patients.Results:There were 140 males and 99 females enrolled in this study.The ratio of male to female was 1.41:1.The median age was 4.4 years old and the median number of WBC at initial stage was 4.98×10^(9)/L.There were 77 cases relapsed during the observation while 162 without relapsed,16 cases lost to follow-up and 72 cases died.The recurrence and mortality rate was 32.22%and 30.1%,respectively,in which 45 cases died of recurrence(62.5%of the total deaths).Univariate analysis showed that the age≥6 years old,WBC>100×10^(9)/L,the bone marrow blasts on day 15≥25%,the bone marrow minimal residual disease(MRD)at week 12>10^(9),and the higher risk were the main factors affecting the recurrence of the patients(P<0.05).Multivariate COX regression analysis showed that age≥6 years old,WBC>100×10^(9)/L,bone marrow MRD>10^(-4) at the 12 th week were the independent risk factors affecting recurrence of the patients.Conclusion:Age,initial WBC,and bone marrow MRD at the 12 th week were correlated with recurrence in children with B-ALL without prognostic fusion genes,which can be used as prognostic indices of recurrence risk in clinical.

关 键 词：急性淋巴细胞白血病 复发 儿童 预后 无预后标志性基因 

分 类 号：R733.71[医药卫生—肿瘤]