儿童T系急性淋巴细胞白血病的临床特点及预后分析

Analysis of Clinical Features and Prognostic Significance of Childhood T-lineage Acute Lymphoblastic Leukemia

本研究旨在探讨儿童T系急性淋巴细胞白血病(T-ALL)的临床特征与预后。回顾性分析2005年1月到2010年8月我院血液科收治的初诊T-ALL 38例患儿的临床资料,并随机抽取B系ALL中危组、高危组患儿共78例作为对照,比较两者泼尼松试验敏感率、诱导化疗第33天完全缓解(CR)率、复发率及3年无事件生存(EFS)率。结果表明,T-ALL与B-ALL两者在年龄、肝脾淋巴结肿大、中枢神经系统浸润及染色体异常、融合基因比例等方面的差异无统计学意义(p>0.05);与B系ALL患儿比较,T系ALL患儿在性别构成、白细胞计数≥50×109/L比例的差异均有统计学意义(p<0.05)。T-ALL、B-ALL患儿对泼尼松预处理敏感率分别为51.9%和89.3%,差异有统计学意义(p<0.05),而两组患儿诱导化疗未缓解率分别为15.4%、8.1%,差异无统计学意义(p>0.05)。26例T系ALL患儿中有8例(30.8%)复发,74例B-ALL患儿中有11例(14.9%)复发。T系和B系ALL患儿CR至复发时间分别为(9.78±3.48)个月和(21.28±14.32)个月(p<0.05)。中、高危组B-ALL和中、高危组T-ALL患儿Kaplan-Meier生存曲线分析显示,3年EFS率分别为(66.7±7)%、(37.5±17.1)%、(51.7±9.3)%、(22.2±9.8)%(p<0.05)。结论:与B-ALL患儿相比T-ALL男性比例和初诊白细胞数均较高,且早期泼尼松反应和3年EFS率均较B-ALL差。

This study was aimed to explore the clinical features and prognosis outcome of childhood T-cell acute lymphoblastic leukemia（T-ALL）.The clinical data of 38 cases of newly diagnosed T-ALL from Jan 2005 to Aug 2010 were analyzed retrospectively,and 78 cases of B-ALL with intermediate and high risk were collected as control group,then the sensitive rate of patients to prodnisone pretreatment,complete remission（CR） rate at day 33 after induction chemotherapy,relapse rate and 3-year event-free survival（EFS） were compared between T-ALL and B-ALL childreen.The results showed that no significant statistic difference were found in distribution of age,infiltration of liver,spleen and lymphnodes as well as central nervous system disease,chromosome abnormality,expression level of fusion gene and so on between T-ALL and B-ALL groups（p〈0.05）,but there were significant differences in sex and number of cases with WBC count ≥50×10^9/L between them（p〈0.05）.The sensitive rate of T-ALL and B-ALL patients to prednisone pretreatment was 51.9% and 89.3% respectively（p〈0.05）.The ratio failed to achieve CR at day 33 after induction chemotherapy was 15.4% and 8.1% in the two groups（p〈0.05）.The relapse rate of T-ALL and B-ALL cases was 30.8%（8/26） and 14.9%（11/74） respectively（p〈0.05）.The time from CR to relapse was（9.78±3.48） month and（21.28±14.32） month（p〈0.05）.The 3 year EFS of T-ALL cases with intermediate and high risk was（37.5±17.1）% and（22.2±9.8）%,while 3 year EFS of B-ALL cases was（66.7±7）% and（51.7±9.3）% respectively（p〈0.05） according to Kaplan-Meier survival curve.It is concluded that as compared with B-ALL cases,the male ratio and initial WBC count are higher,moreover the early response to prednisone pretreatment and 3 year EFS are poor in T-ALL cases,the prognosis outcome is poor also.