儿童急性T淋巴细胞白血病预后影响因素分析——CCCG-ALL-2015方案单中心临床研究  

Prognostic factors in children with acute T-lymphoblastic leukemia:a single-center clinical study of the CCCG-ALL-2015 protocol

作　　者：付文凤 方拥军[1] FU Wen-Feng;FANG Yong-Jun(Department of Hematology and Oncology,Children′s Hospital of Nanjing Medical University,Nanjing 210008,China)

机构地区：[1]南京医科大学附属儿童医院血液肿瘤科,江苏南京210008

出　　处：《中国当代儿科杂志》2024年第10期1078-1085,共8页Chinese Journal of Contemporary Pediatrics

基　　金：江苏省自然科学基金面上项目(BK20211009)。

摘　　要：目的探讨儿童急性T淋巴细胞白血病(acute T-lymphoblastic leukemia,T-ALL)患儿的临床特征,并分析其与预后的关系。方法回顾性分析2015年11月—2019年12月南京医科大学附属儿童医院血液肿瘤科采用CCCG-ALL-2015方案诊治的50例T-ALL患儿的临床资料及随访结果,运用Kaplan-Meier生存分析、Cox回归分析等方法分析患儿预后的影响因素。结果50例T-ALL患儿中,共复发7例。复发组和非复发组基本临床资料的比较差异无统计学意义(P>0.05)。复发组诱导缓解治疗后第46天微小残留病(minimal residual disease,MRD)阳性率(≥0.01%)高于非复发组,差异有统计学意义(P=0.037)。50例患儿5年总体生存率为(87±5)%,5年无事件生存率为(86±5)%。多因素Cox回归分析显示诱导缓解治疗后第46天MRD水平是预后的独立影响因素(HR=0.104,95%CI:0.015~0.740,P=0.024)。结论MRD对T-ALL患儿的预后有重要意义,临床上需根据MRD水平提供个性化治疗,预防复发、改善预后。Objective To explore the clinical characteristics of children with acute T-lymphoblastic leukemia(T-ALL)and analyze their relationship with prognosis.Methods A retrospective analysis was conducted on the clinical data and follow-up results of 50 children with T-ALL who were treated using the CCCG-ALL-2015 protocol at the Department of Hematology and Oncology,Children′s Hospital of Nanjing Medical University from November 2015 to December 2019.Kaplan-Meier survival analysis and Cox regression analysis were employed to identify factors affecting prognosis.Results Among the 50 T-ALL patients,there were 7 cases of relapse.There was no statistically significant difference in the baseline clinical data between the relapse group and the non-relapse group(P>0.05).However,the positive rate of minimal residual disease(MRD)(≥0.01%)on day 46 after induction remission therapy in the relapse group was significantly higher than that in the non-relapse group(P=0.037).The 5-year overall survival rate for the 50 patients was(87±5)%,and the 5-year event-free survival rate was(86±5)%.Multivariate Cox regression analysis indicated that the MRD level on day 46 after induction remission therapy was an independent prognostic factor(HR=0.104,95%CI:0.015-0.740,P=0.024).Conclusions MRD is of significant importance for the prognosis of T-ALL children.Personalized treatment should be provided based on MRD levels to prevent relapse and improve prognosis in these patients.

关 键 词：急性T淋巴细胞白血病 微小残留病 临床特征 预后 危险因素 儿童 

分 类 号：R733.71[医药卫生—肿瘤]