糖皮质激素诱导试验在儿童急性淋巴细胞白血病早期预后评估中的应用

Use of glucocorticosteroid induction test to predict the early prognosis of children with acute lymphoblastic leukemia

目的评价糖皮质激素诱导试验在儿童急性淋巴细胞白血病（ALL）早期预后评估中的作用。方法收集2010年10月至2013年10月ALL患儿85例，年龄1．6—14岁，中位年龄5岁，其中男性44例，女性41例；B-ALL82例（96．5％），T-ALL3例（3．5％）。患儿均给予7d糖皮质激素治疗，根据第8天外周血幼稚细胞动态变化分为激素反应良好（PGR）组和激素反应不良（PPR）组，根据两组患儿临床特点和治疗后转归，判断糖皮质激素诱导试验评估早期预后的价值。结果PGR组78例（91．8％），其中高危患儿7例（8．2％），中危患儿40例（51．3％），低危患儿31例（39．7％）；PPR组7例（8．24％），均为高危。治疗第15天骨髓检查示：PPR组M，型（原始幼稚淋巴细胞〈0．05）2例，非M，型5例；PGR组M1型74例（94．9％），非M，型4例（5.1％）。化疗后PPR组中1例持续完全缓解（CCR），1例放弃治疗，3例复发，2例死亡；PGR组中65例CCR，4例放弃治疗，7例复发，2例死亡。随访期3～48个月，中位随访26个月，PGR组无事件生存（EFS）率为83．3％（65／78），PPR组EFS率为14．3％（1／7）。结论大部分ALL患儿对糖皮质激素敏感，预后较好；对糖皮质激素不敏感患儿，要密切关注白血病其他生物学指标。糖皮质激素诱导试验可能是评估儿童ALL早期预后的一项重要指标。

Objective To evaluate the effect of glucocorticosteroid induction test on the early prognosis of children with acute lymphoblastic leukemia （ALL）. Methods All 85 patients were collected from October 2010 to October 2013, the age was 1.6-14 years old, the median age was 5 years old, 44 males, 41 females. In the immunophenotype, the B-ALL was 96.5 % （82 cases）, T-ALL was 3.5 % （3 cases）. All patients received glucocorticosteroid induction test for 7 days and were divided into prednison good response （PGR） group and prednison poor response （PPR） group according to the dynamic changes of the blast ceils in the peripheral blood on day 8, clinical materials were combined to predict the early prognosis. Results Of 85 children, 78 children （91.8 %） including 7 in high risk, 40 in intermediate risk and 31 in low risk showed PGR, and 7 children （8.2 %） of the high risk belonged to PPR. Bone marrow was examined on the 15 days after treatment, M1 state was reached in PPR and PGR group with 2 cases （28.6 %） and 74 cases （94.9 %） respectively. While 5 cases （71.4 %） and 4 cases （5.1%） didn＇ t achieved MI respectively. In the PPR group, 1 child achieved continuous complete remission （CCR）, 1 gave up, 3 relapsed and 2 died. In the PGR group, 65 patients remained in CCR, 4 gave up, 7 relapsed and 2 died. The follow-up time was 3-48 months, the median time was 26 months, the event free survival （EFS） rate of PGR group was 83.3 % （65/78）, the EFS rate of PPR group was 14.3 % （1/7）. Conclusions The response to glucocorticosteroid in children with ALL is majority sensitive, so their prognosis is good. For children belonging to PPR group, the other biological indicators should be followed. The glucocorticosteroid induction test is an important factor in predicting the early prognosis of children with ALL.