Blinatumomab治疗儿童急性淋巴细胞白血病临床疗效分析  

Clinical efficacy of Blinatumomab in children with acute lymphoblastic leukemia

作　　者：王玉平[1] 梁卉[1] 魏平平 丁雯雯[1] 李丹妮[1] 庄超[1] 张磊[1] WANG Yuping;LIANG Hui;WEI Pingping;DING Wenwen;LI Danni;ZHUANG Chao;ZHANG Lei(Department of Hematology,Women and Children′s Hospital Affiliated to Qingdao University,Qingdao 266000,China)

机构地区：[1]青岛大学附属妇女儿童医院血液科,青岛266000

出　　处：《中国小儿血液与肿瘤杂志》2025年第1期58-62,共5页Journal of China Pediatric Blood and Cancer

摘　　要：目的探讨Blinatumomab治疗儿童急性淋巴细胞白血病(ALL)的临床疗效。方法收集2021年1月—2023年12月就诊于青岛大学附属妇女儿童医院血液儿科接受Blinatumomab治疗的21例ALL患儿相关临床资料,采用SPSS统计学软件进行分析,探讨分析其临床疗效。结果本研究中诱导化疗结束后MRD或融合基因未转阴患儿7例,不耐受强化疗10例,复发者4例,治疗后患儿的骨髓细胞学形态均完全缓解,仅1例患儿MRD阳性,治疗前后融合基因阳性率有显著性差异。治疗后患儿的脑脊液白细胞计数显著升高,调节性淋巴细胞亚群增多,可能与Blinatumomab治疗后T细胞活化,同时使血脑屏障通透性增加,进入脑脊液中的T细胞增多有关。结论复发性、诱导化疗结束后MRD或融合基因未转阴及不耐受强化疗CD19阳性B-ALL患儿可接受Blinatumomab治疗,提高缓解率,但需注意,Blinatumomab治疗会使患儿的脑脊液白细胞数升高,建议在治疗后行脑脊液流式细胞学检测,以区分是T细胞浸润或中枢神经系统白血病细胞浸润。Objective To analyze the clinical efficacy of Blinatumomab on acute lymphoblastic leukemia(ALL).Methods The related clinical data of 21 children with ALL treated with Blinatumomab in the Department of Hematology,Women and Children′s Hospital Affiliated to Qingdao University from January to December 2019 were collected.SPSS statistical software was used to analyze the clinical efficacy of Blinatumomab.Results In this study,7 children were MRD or fusion gene did not turn negative after the end of induction chemotherapy,10 were intolerant to strong chemotherapy,and 4 relapsed.The bone marrow cytological morphology of the children was completely resolved after treatment,and only 1 child was MRD positive,with significant difference in the positive rate of fusion gene before and after treatment.After treatment,the leukocyte count and regulatory lymphocyte subsets increased significantly in the cerebrospinal fluid,which may be related to the activation of T cells after Blinatumomab treatment,the increase of the permeability of the blood-brain barrier and the increase of T cells entering the cerebrospinal fluid may be the reason.Conclusions Recurrent,MRD or fusion gene did not turn negative after the end of induction chemotherapy and intolerant CD19-positive B-ALL can be treated with Blinatumomab to improve the remission rate.However,it should be noted that Blinatumomab treatment will increase the white blood cell count in the cerebrospinal fluid,and cerebrospinal fluid flow cytometry detection is recommended after treatment to distinguish T cell infiltration and central nervous system leukemia cell infiltration.

关 键 词：急性淋巴细胞白血病 儿童 Blinatumomab 临床疗效 

分 类 号：R733.71[医药卫生—肿瘤]