儿童非成熟B淋巴细胞性白血病预后因素分析

Prognostic factors for childhood acute non-mature B-lymphoblastic leukemia

目的分析多种预后影响因素对儿童非成熟B细胞性白血病长期无病生存的影响,寻找可能的影响治疗和预后的最重要的因素。方法对在该院确诊并接受治疗的非成熟B淋巴细胞性白血病患儿161例,按ALL-XH-99方案化疗。并在治疗前获得患者年龄、性别、外周血白细胞数、免疫分型、P170、融合基因以及泼尼松治疗第8天外周血幼稚细胞绝对数、诱导缓解治疗第19天骨髓象以及诱导缓解治疗结束时骨髓微量残留病(MRD)水平和危险度分级等,并动态观测治疗疗效。结果单因素分析显示:性别、治疗前P170水平等对治疗对无事件生存率无影响(P>0.05);年龄、治疗前外周血白细胞水平、泼尼松治疗反应、诱导缓解第19天骨髓象、融合基因、以及CR时MRD水平等则具有显著相关性(P<0.01);免疫分型、是否具有髓系标记以及临床危险度分组对治疗预后亦具有一定程度的影响(<0.05)。多因素COX回归分析结果显示,在所有进入本研究的各种因素的综合分析中,预后危险因素包括:治疗前外周血WBC≥50×109/L、Cμ阳性、MRD阳性以及融合基因检测阳性等(P<0.05)。而性别、年龄、治疗前P170水平、CD10/CD33/CD13是否表达、危险度分组以及治疗第19天骨髓象等对预后并无显著的影响(P>0.05)。但根据患者治疗第19天骨髓象调整治疗方案具有重要意义。结论在非成熟B系ALL中,治疗前外周血高白细胞数、Cμ阳性、融合基因检测阳性以及诱导缓解结束后MRD≥0.01%具有重要的预后意义。而早期治疗反应(第19天骨髓象)对于指导治疗具有重要意义。

Objective To study the prognostic factors for events-free survival （EFS） in children with acute nonmature B-lymphoblastic leukemia. Methods One hundred and sixty-one children with newly diagnosed acute non-mature B-lymphoblastic leukemia received the ALL-XH-99 protocol treatment. Their medical data, including clinical, biological and molecule features, early responses to treatment （bone marrow evaluation on the 19th day of induction therapy）, minimal residual disease （MRD） in bone marrow after remission induction therapy, the risk grade of disease before the beginning of chemotherapy and the outcome, were retrospectively studied. Results Univariable analysis indicated that the gender and P170 levels before therapy had no effect on the outcome. Age, initial white blood cell count （WBC）, prednisone response, early response to treatment, fusion genes （BCR/ABL or MLL/AF4 ） and MRD level were significantly related to the EFS （P 〈 0.01 ）. Immunophenotype, myeloid-associated antigen and the risk grade of disease were also related to the EFS （P 〈 0.05 ）. Multivariable analysis showed that WBC I〉50 x 109/L, Cμ positive, BCR/ABL or MLL/AF4 positive and MRD positive （ ≥0.01% ） were risk factors for the poor prognosis （P 〈 0.01 ）. The early response to treatment was important to modify the therapy protocol. Conclusions WBC 〉150 x 109/L, Cμ positive, BCR/ABL or MLL/AF4 positive and MRD positive have important prognostic values in childhood acute non-mature Blymphoblastic leukemia. Early response to treatment is an important index for modifying the chemotherapy protocol.