利妥昔单抗用于初诊CD20阳性B-ALL患儿的效果及预后分析  

Analysis on effect and prognosis of rituximab in children patients with newly diagnosed CD20 positive B-ALL

作　　者：王健[1] 马林楠 WANG Jian;MA Linnan(Department of Hematology and Oncology,Xi′an Children′s Hospital,Xi′an,Shaanxi 710003,China;Department of Pharmacy,Xi′an Children′s Hospital,Xi′an,Shaanxi 710003,China)

机构地区：[1]西安市儿童医院血液肿瘤科,陕西西安710003 [2]西安市儿童医院药学部,陕西西安710003

出　　处：《检验医学与临床》2023年第12期1716-1720,共5页Laboratory Medicine and Clinic

摘　　要：目的观察利妥昔单抗辅助CCLG-ALL2008方案治疗初诊CD20阳性B系急性淋巴细胞白血病(B-ALL)患儿的疗效,探讨影响患儿预后的相关因素,并建立预后风险系数模型。方法收集2018年5月至2020年5月在该院初诊CD20阳性B-ALL的168例患儿的临床资料进行回顾性分析。根据治疗方法不同分为对照组(84例,采用CCLG-ALL2008方案治疗)和观察组(84例,采用利妥昔单抗联合CCLG-ALL2008方案治疗)。比较两组治疗效果和治疗期间不良反应的发生情况,分析影响观察组患儿预后的相关因素,并建立风险系数模型。结果观察组患儿近期疗效显著优于对照组(P<0.05),两组患儿治疗期间不良反应发生情况比较,差异无统计学意义(P>0.05)。Cox回归模型分析显示T315I突变、FLT3突变、微小残留病灶(MRD)阳性及MLL/AF4阳性是观察组患儿预后的独立影响因素(P<0.05)。风险系数模型=0.287×X_(T315I突变)+0.940×X_(FLT3突变)+0.954×X_(MRD阳性)+1.416×X_(MLL/AF4阳性)。受试者工作特征(ROC)曲线分析结果显示该风险系数模型判断预后的AUC为0.840(95%CI:0.696~0.985,P<0.001),灵敏度为0.846,特异度为0.746。结论利妥昔单抗联合CCLG-ALL2008方案治疗初诊CD20阳性B-ALL患儿效果显著,其预后可能与T315I突变、FLT3突变、MRD阳性及MLL/AF4阳性相关,临床据此建立的风险系数模型对预后判断具有较高的准确性。Objective To observe the efficacy of rituximab in assisted CCLG-ALL2008 regimen for treating the children patients with newly diagnosed CD20 positive B-line acute lymphoblastic leukemia(B-ALL),to investigate the relevant factors affecting their prognosis and to establish the prognosis risk coefficient model.Methods The clinical data of 168 children patients with newly diagnosed CD20 positive B-ALL in this hospital from May 2018 to May 2020 were collected and retrospectively analyzed.The patients were divided into the control group(84 cases,treated with the CCLG-ALL2008 regimen)and observation group(84 cases,treated with rituximab combined with the CCLG-ALL2008 regimen)according to the different treatment methods.The treatment effects and adverse reactions during the treatment period were compared between the two groups,the relevant factors affecting the prognosis of the children patients in the observation group were analyzed,and the risk coefficient model was established.Results The short-term efficacy of the observation group was significantly better than that of the control group(P<0.05),and there was no statistically significant difference in the adverse reactions occurrence situation during treatment period between the two groups(P>0.05).The Cox regression model analysis showed that the T315I mutation,FLT3 mutation,minimal residual lesions(MRD)positive and MLL/AF4 positive were the independent factors affecting the prognosis of the children patients(P<0.05).The riscoefficient model=0.287×X_(T315I mutation)+0.940×X_(FLT3 mutation)+0.954×X_(MRD positive)+1.416×X_(MLL/AF4 positive).The receiver operating characteristic(ROC)curve analysis results showed that the area under the curve(AUC)of the risk coefficient model for judging the prognosis was 0.840(95%CI:0.696-0.985,P<0.001),the sensitivity was 0.846,and the specificity was 0.746.Conclusion The rituximab combined with CCLG-ALL2008 regimen has significant effect in treating the children patients with newly diagnosed CD20 positive B-ALL,and its prognosis ma

关 键 词：利妥昔单抗 CCLG-ALL2008方案 CD20阳性 B系急性淋巴细胞白血病 预后 

分 类 号：R733.71[医药卫生—肿瘤]