干/髓系免疫表型对儿童T-急性淋巴细胞白血病预后影响研究

Clinical significance of stem cell or myeliod antigen expression in children with T-cell acute lymphoblastic leukemia

目的探讨干/髓系表面抗原标记对儿童T-急性淋巴细胞白血病的预后影响。方法回顾性分析2002-01-01至2008-12-31上海交通大学医学院附属儿童医学中心收诊的57例T细胞型急性淋巴细胞白血病(ALL)和伴有骨髓转移的T细胞性淋巴母细胞型非霍奇金淋巴瘤(NHL)患儿干/髓系表面抗原表达情况,将其分为T-ALL伴有髓系表达组(T/My+ALL)和无髓系表达组(T/My-ALL),分析其与预后的相关性。结果T/My+ALL组31例(54.6%)和T/My-ALL组26例(45.4%),两组细胞形态学、遗传学及临床特征差异均无统计学意义(P>0.05);近期疗效中,泼尼松诱导实验差异无统计学意义(P>0.05),19d骨髓象及第1疗程完全缓解率T/My+ALL组均较T/My-ALL组低,差异有统计学意义(P值分别为0.002和0.006);T/My+ALL组和T/My-ALL组的初治完全缓解率分别为90.3%和96.2%,5年无事件生存率分别为35.4%和65.7%。虽结果提示T/My+ALL组预后较T/My-ALL组差,但差异无统计学意义(P=0.209)。结论T-ALL/NHL伴有干/髓系表面抗原表达时预后差,但未达到统计学有效意义,目前尚不能将之作为儿童T系淋巴细胞白血病的预后因素。

Objective To investigate the prognosis of children T-cell acute lymphoblastic leukemia （T-ALL） with stem cell or myeloid antigen. Methods A total of 57 children with T-cell ALL or lymphoblastic non-Hodgkiu＇ s lymphoma metastasized to bone marrow were subclassified into stem cell or myeliod antigen positive T-ALL（T/My＋ALL） and stem cell or myelnid antigen negative T-ALL （T/My-ALL）. Results Totally 31 （54.6%） cases were T/My ＋ ALL, and 26 （45.4%） T/My-ALL. There was no relationship between stem cell or myeloid antigen expression and eyto-morphology, genetics and clinical characters in T-ALL（P 〉 0.05）; T/My＋ALL was not different from T/My-ALL in 7 days prednisone inducement （P 〉 0.05）. But compared with T/My-ALL, T/My ＋ALL patients had a poor result on day 19 induction therapy （P=0.002）, and a low complete remission rate on day 35 induction therapy （P = 0.006）. The complete remission rates of T/My＋ALL and T/My-ALL were 90.3% and 96.2% ; 5-year event-free survival （EFS） was 35.4% and 65.7% respectively, though it indicated T/My ＋ ALL patients had a poor prognosis; there was no significance （P 〉 0.05）. Conclusion Stem cell or myeloid antigen expression in T-ALL/NHL can not be considered as a poor prognosis factor by now.