儿童急性T淋巴细胞白血病的临床特征及预后分析  

Clinical features and prognosis of childhood T-cell acute lymphoblastic leukemia

作　　者：张蕾[1] 岳梅[1] 玄立田 钟笛箫[1] 李娟娟[1] 宋泽亮[1] 黄贵民 刘嵘[1] ZHANG Lei;YUE Mei;XUAN Litian;ZHONG Dixiao;LI Juanjuan;SONG Zeliang;HUANG Guimin;LIU Rong(Department of Hematology,2.Child Health Big Data Research Center,Children′s Hospital Affiliated to Capital Institute of Pediatrics,Beijing 100020,China)

机构地区：[1]首都儿科研究所附属儿童医院血液科,北京100020 [2]首都儿科研究所附属儿童医院儿童健康大数据研究中心,北京100020

出　　处：《中国小儿血液与肿瘤杂志》2023年第1期4-8,20,共6页Journal of China Pediatric Blood and Cancer

摘　　要：目的分析儿童急性T淋巴细胞白血病(T-ALL)的临床特征、预后因素及生存情况。方法回顾性分析2008年4月—2020年8月于首都儿科研究所附属儿童医院血液内科确诊的84例T-ALL临床和实验室资料。并将非早前T淋巴细胞(non-ETP)-ALL组与早前T淋巴细胞(ETP)-ALL组进行比较。结果non-ETP组共70例(83.3%),ETP组共14例(16.7%)。与non-ETP组相比,ETP组女性比例高、LDH明显增高者比例低、高危者比例高、诱导失败者比例高(P<0.05)。non-ETP组完全缓解(CR)率为87.1%,ETP-ALL组CR率为57.1%。non-ETP组复发19例,死亡15例;ETP组复发3例,死亡3例。non-ETP-ALL及ETP-ALL组的5年的总生存率(OS)分别为:(77.1±5.3)%vs.(74.5±13.1)%(P=0.979)。两组患儿5年的无事件生存率(EFS)分别为:(64.2±6.0)%vs.(50±13.4)%(P=0.098)。通过Kaplan-Meier分析进行单因素分析显示,诱导失败及复发为影响OS的因素(P<0.05)。采用Cox多因素分析显示,复发为影响预后的独立因素(P<0.001)。纳入所有因素进行logistic回归分析显示,高危险度将直接增加复发风险,具有统计学意义(P=0.047)。结论儿童T-ALL诱导失败及复发为预后影响因素,复发为预后的独立危险因素。non-ETP-ALL组与ETP-ALL组的5年OS及EFS均无明显统计学差异。Objective To analyze the clinical features,prognostic factors and survival of children with T-cell acute lymphoblastic leukemia(T-ALL).Methods Clinical and laboratory data of 84 cases of newly diagnosed T-ALL in Department of Hematology,Children′s Hospital Affiliated to Capital Institute of Pediatrics from April 2008 to August 2020 were analyze retrospectively.The data of non-early T-cell precursor ALL(non-ETP-ALL)was compared to data of the early T-cell precursor ALL(ETP-ALL).Results A total of 70(83.3%)non-ETP-ALL and 14(16.7%)ETP-ALL were enrolled in this study.The CR rate in the non-ETP group was 87.1%and 57.1%in the ETP-ALL group.Nineteen cases relapsed and 15 cases died in the non-ETP group.In the ETP group,there were 3 cases of recurrence and 3 cases of death.The 5-year overall survival rates(OS)of the non-ETP-ALL and ETP-ALL were 77.1%±5.3%vs.74.5%±13.1%(P=0.979)and the five-year event-free survival(EFS)were 64.2%±6.0%vs.50%±13.4%(P=0.098).Univariate analysis showed that the failure to achieve CR after induction therapy and relapse were prognosis factors for OS(P<0.05),and relapse was the independent prognosis factor for OS(P<0.001).Logistic regression analysis showed that high risk significantly increased the risk of relapse(P=0.047).Conclusions Induction failure and relapse are prognostic factors.Relapse is the independent prognosis factor for OS.There were no significant differences between non-ETP-ALL and the ETP-ALL in 5-year OS and EFS rate.

关 键 词：白血病 T细胞 早前T淋巴细胞 儿童 临床特征 预后 

分 类 号：R733.71[医药卫生—肿瘤]