摘要
目的:通过分析CCLG-ALL 2008方案治疗无预后标志性融合基因的急性B淋巴细胞白血病(B-ALL)患儿的疗效,并分析影响复发的相关因素。方法:回顾性分析239例于2008年3月至2012年12月在苏州大学附属儿童医院诊断为B-ALL、多重RT-PCR未检测到预后标志性融合基因,且接受CCLG-ALL 2008方案化疗的患儿,随防到2019年8月31日,中位随访时间92(0-136)个月。Kaplan-Meier分析无复发生存时间(RFS),COX多因素回归分析复发相关的独立因素。结果:239例患儿中男性140例,女性99例,男女比例1.41∶1,中位诊断年龄4.4岁,初诊白细胞中位数是4.98×10^(9)/L,复发77例,非复发162例,失访16例,死亡72例。复发率和死亡率分别为32.22%和30.1%,其中45例死于复发(占总死亡人数62.5%)。对复发危险因素进行单因素分析,发现初诊年龄≥6岁、初诊白细胞计数>100×10^(9)/L、d15骨髓原始细胞≥25%、第12周骨髓微小残留病(MRD)>10^(-4)以及最终危险度为高危是影响复发的主要因素(P<0.05)。多因素COX回归分析显示,年龄≥6岁、初诊白细胞数>100×10^(9)/L、第12周骨髓MRD>10^(-4)是复发的独立危险因素。结论:年龄、初诊白细胞计数、第12周骨髓MRD与无预后标志性融合基因B-ALL患儿复发相关,在临床工作中可作为评估患儿复发风险的预后指标。
Objective:To analyze the efficacy of children with B-cell acute lymphoblastic leukemia(B-ALL)without prognostic fusion genes treated by CCLG-ALL 2008,and investigate the related factors affecting the recurrence of the patients.Methods:B-ALL patients without prognostic fusion genes treated by the protocol of CCLG-ALL 2008 in our hospital from March 2008 to December 2012 were retrospectively analyzed.Follow-up time was ended in August 31,2019.The median follow-up time was 92 months(range 0-136 months).Kaplan-Meter was used to detect the RFS,and COX multivariate regression analysis was employed to identify the independent factors affecting the recurrence of the patients.Results:There were 140 males and 99 females enrolled in this study.The ratio of male to female was 1.41:1.The median age was 4.4 years old and the median number of WBC at initial stage was 4.98×10^(9)/L.There were 77 cases relapsed during the observation while 162 without relapsed,16 cases lost to follow-up and 72 cases died.The recurrence and mortality rate was 32.22%and 30.1%,respectively,in which 45 cases died of recurrence(62.5%of the total deaths).Univariate analysis showed that the age≥6 years old,WBC>100×10^(9)/L,the bone marrow blasts on day 15≥25%,the bone marrow minimal residual disease(MRD)at week 12>10^(9),and the higher risk were the main factors affecting the recurrence of the patients(P<0.05).Multivariate COX regression analysis showed that age≥6 years old,WBC>100×10^(9)/L,bone marrow MRD>10^(-4) at the 12 th week were the independent risk factors affecting recurrence of the patients.Conclusion:Age,initial WBC,and bone marrow MRD at the 12 th week were correlated with recurrence in children with B-ALL without prognostic fusion genes,which can be used as prognostic indices of recurrence risk in clinical.
作者
蒋梦影
高伟
高静
凌婧
潘健
肖佩芳
卢俊
何海龙
王易
李捷
李建琴
柴忆欢
孙伊娜
胡绍燕
JIANG Meng-Ying;GAO Wei;GAO Jing;LING Jing;PAN Jian;XIAO Pei-Fang;LU Jun;HEHai-Long;WANG Yi;LI Jie;LI JIAN-Qin;CHAI Yi-Huan;SUN Yi-Na;HU Shao-Yan(Department of Hematology,Children's Hospital of Soochow University,Suzhou 215025,Jiangsu Province,China)
出处
《中国实验血液学杂志》
CAS
CSCD
北大核心
2022年第1期12-17,共6页
Journal of Experimental Hematology
基金
江苏省创新团队资助课题(CXTDA2017014)
江苏省重点课题(BE2017658,BE2017659,BK20180053)
苏州市科技局资助课题(SS201809,BE2017659)。
