儿童急性淋巴细胞白血病基线数据及早期治疗反应与预后的相关性  

Correlation analysis of baseline data,early treatment response and prognosis in children with acute lymphoblastic leukemia

作　　者：杨敏 潘艳莎 张长玲 陈红英 郭渠莲 刘文君 YANG Min;PAN Yansha;ZHANG Changing;CHEN Hongying;GUO Quian;LIU Wenjun(Department of Pediatrics,the Affiliated Hospital of Southwest Medical University,Sichuan Clinical Research Center for Birth Defects,Luzhou 646000,China)

机构地区：[1]西南医科大学附属医院儿科,四川省出生缺陷临床医学研究中心,646000

出　　处：《天津医药》2024年第9期954-958,共5页Tianjin Medical Journal

基　　金：四川省科技计划项目(2022YFS0622)。

摘　　要：目的 探讨急性淋巴细胞白血病(ALL)患儿的基线数据及早期治疗反应与预后的相关性。方法 92例ALL患儿依据是否出现终点事件(复发或死亡)分为终点事件组(19例)和无事件生存组(73例),统计初诊年龄、性别,检测初诊白细胞计数(WBC)、初诊血小板计数(PLT)、免疫分型、染色体核型、融合基因、泼尼松试验反应、诱导化疗第15天骨髓缓解状态及诱导化疗第15、33、55天微小残留病变(MRD),分析上述基线数据及早期治疗反应与ALL患儿出现终点事件的相关性。采用Logistic回归分析ALL患儿出现终点事件的影响因素,绘制受试者工作特征(ROC)曲线,并评估基线数据及早期治疗反应对ALL患儿出现终点事件的预测价值。结果 终点事件组患儿初诊WBC≥100×10^(9)/L、泼尼松反应不良及诱导化疗第33天MRD阳性占比均高于无事件生存组(P<0.05),余指标差异均无统计学意义(P>0.05)。Logistic回归分析显示,泼尼松反应不良、诱导化疗第33天MRD阳性是ALL患儿出现终点事件的危险因素(P<0.05),二者联合预测ALL患儿出现终点事件的价值优于单一指标。结论 ALL患儿泼尼松反应不良、诱导化疗第33天MRD阳性与ALL复发及治疗相关性死亡相关。Objective To investigate the correlation between baseline data,early treatment response and prognosis in children with acute lymphoblastic leukemia(ALL).Methods Ninety-two children with ALL were divided into the endpoint event group(19 cases)and the event-free survival group(73 cases)according to whether there was an endpoint event(recurrence or death).The age and gender at initial diagnosis were recorded.Initial white blood cell count(WBC),platelet count(PLT),immunophenotype,chromosome karyotype,fusion gene,prednisone test,bone marrow remission status on the 15th day of induction chemotherapy and minimal residual disease(MRD)on the 15th,33rd and 55th day of induction chemotherapy were detected.The correlation between the above baseline data and early treatment response and the occurrence of endpoint event in children with ALL was analyzed.Logistic regression was used to analyze influencing factors of endpoint events in children with ALL.Receiver operating characteristic(ROC)curve was plotted to evaluate the predictive value of baseline data and early treatment response to endpoint events in children with ALL.Results The proportion of WBC≥100×10^(9)/L at first diagnosis,prednisone poor reaction and positive MRD on the 33rdday of induction chemotherapy were higher in the endpoint event group than those in the event-free survival group(P<0.05),and there were no significance differences in remaining indicators(P>0.05).Logistic regression analysis showed that prednisone poor reaction and positive MRD on the 33rdday of induction chemotherapy were risk factors for endpoint event in children with ALL(P<0.05),and the combined value of the two indicators was better than that of a single indicator in predicting endpoint events in children with ALL.Conclusion Prednisone poor reaction and positive MRD on the 33rdday of induction chemotherapy are associated with recurrence and death in children with ALL.

关 键 词：前体细胞淋巴母细胞白血病淋巴瘤 肿瘤 残余 预后 儿童 早期治疗反应 

分 类 号：R725.5[医药卫生—儿科]