动态观察端粒酶活性在儿童急性淋巴细胞白血病预后判断中的意义  

Prognostic significance of early response to therapy and minimal residual diseases detection in childhood acute lymphoblastic leukemia

作　　者：于亚平[1] 楼国良[2] 杨继红[1] 史平[1] 刘海宁[1] 翟勇平[1] 唐玉梅[1] 虞伟[3] 

机构地区：[1]第二军医大学南京临床学院南京军区南京总医院血液科 [2]第二军医大学长海医院血液科,上海200433 [3]南京军区南京总医院解放军医学检验中心,江苏南京210002

出　　处：《医学研究生学报》2004年第5期430-432,共3页Journal of Medical Postgraduates

摘　　要：目的 :研究儿童急性淋巴细胞白血病 (ALL)的治疗及其相关预后因素。　方法 :以多药联合化疗方案进行诱导缓解和缓解后治疗 ,以诱导治疗第 1 4天的骨髓原始淋巴细胞比例作为治疗反应敏感性指标 ,以端粒重复序列扩增 银染色技术检测端粒酶活性作为微小残留白血病指标。　结果 :90 % (1 9/ 2 1 )的儿童ALL获完全缓解(CR)。在中位随访时间 5 5 (1 2～ 1 2 0 )个月内 ,6例复发 ,7例已连续完全缓解 (CCR) 2 4～ 5 4个月 ,现仍在连续治疗中 ;6例已停止治疗 1 8～ 6 0个月。全组患儿 5年无复发生存率为 6 5 .5 %。诱导治疗第 1 4天骨髓检查分级为M1(原始细胞为 <5 % )、M2 (原始细胞 5 %～ 2 5 % )和M3 (原始细胞 >2 5 % )型者分别为 6 7%、1 4 %和 1 9%。 1 4例M1 型ALL的 5年无复发生存率明显高于 7例M2 和M3 型 (分别为 84 .6 %和 1 5 .8% ,P <0 .0 1 )。在CR后端粒酶持续阳性或在治疗期间由阴性转为阳性的ALL复发率明显增加。　结论 :诱导治疗第 1 4天骨髓检查结果是判断ALL长期存活的重要预后因素 ;Objective: To investigate the effects of early response to therapy and minimal residual disease detection on treatment outcome in childhood acute lymphoblastic leukemia(ALL). Methods: The residual lymphoblast percentage of bone marrow was evaluated on day 14 during a four drug induction in 21 children with ALL. Telomerase activity of bone marrow cell was determined by telomere repeat amplification protocol(TRAP) silver stain technique at differential clinical stages. Results: The induction complete remission was 90%(19/21). 67%, 14%, and 19% of patients had M 1 (< 5% blasts), M 2 (5%～25% blasts), or M 3 (> 25% blasts) responses on day 14 of induction therapy.5 year EFS for patients who achieved M 1 by day 14 was 84.6%. EFS decreased to 15.8% for those still M 2 or M 3 on day 14. Telomerase activity was detected in 12/14(92.3%) before chemotherapy and in 33.3% (4/12) at complete remission. Persistent positive of telomerase or turning positive at the various follow up times was associated with high relapse probability. Conclusion: The early response to induction treatment was a powerful, independent prognostic factor that could identify patients who were at high risk for relapse and should be monitored closely. Detection of telomerase at any point in the treatment course was a useful predictor of relapse in childhood ALL.

关 键 词：急性淋巴细胞白血病 端粒酶 微小残留白血病 化学治疗 

分 类 号：R557.4[医药卫生—血液循环系统疾病]