急性淋巴细胞白血病儿童骨髓单个核细胞CRLF2高表达的临床意义

Clinical Significance of CRLF2 High Expression in Bone Marrow Mononuclear Cells from Children with Acute Lymphoblastic Leukemia

目的:检测初诊急性淋巴细胞白血病(ALL)儿童的骨髓单个核细胞CRLF2表达水平,并探讨其在儿童ALL中的临床意义。方法:对第一疗程化疗获得完全缓解且有完整随访信息的218例初诊ALL儿童,采用实时荧光定量PCR方法检测骨髓单个核细胞CRLF2表达水平;分析CRLF2表达水平在ALL儿童临床预后中的意义。结果:有完整资料的218例儿童ALL中有28例CRLF2高表达。CRLF2高表达组累计复发率明显高于低表达组(53.6%vs12.6%)(P<0.01),CRLF2高表达组预计5年无复发生存率明显高于低表达组(P<0.01)。标危组中的CRLF2高表达和低表达患儿预计5年无复发生存率的差异无统计学意义(P>0.05),中危组和高危组中CRLF2低表达的患儿预计5年无复发生存率均高于高表达组的儿童(P<0.05)。Cox法分析显示,CRLF2高表达是影响ALL儿童复发的独立危险因素。结论:CRLF2高表达的ALL儿童复发率高,CRLF2高表达是中高危ALL儿童复发高风险的重要预后因素。有必要将CRLF2表达水平作为ALL儿童的危险分层的指标。

Objective:To detect the expression of CRLF2 in bone marrow mononuclear cells from children with newly diagnosed acute lymphoblastic leukemia(ALL) and to explore its clinical significance in pediatric ALL.Methods:A total of 218 children with newly diagnosed ALL who achieveal the complete remission and had the complete follow-up information were selected,and the expression level of CRLF2 in bone marrow mononuclear cells of these children was detected by real-time fluorescent quantitative PCR,and the significance of CRLF2 expression level in clinical prognosis of ALL children was analyzed by using statistical method.Results:28 cases in 218 children with complete data showed high expression of CRLF2.The cumulative recurrence rate in the CRLF2 high expression group was significantly higher than that in the low expression group (53.6% vs 12.6%)(P < 0.01).The predicted 5-year recurrence-free survival rate (RFS) of ALL children with CRLF2 high expression was significantly higher than that of low expression group (P < 0.01).There was no significant difference in the predicted 5-year RFS between ALL children with CRLF2 low and high expression in the standard-risk(SR) group (P > 0.05).The predicted 5-year RFS of ALL children with CRLF2 low expression was higher than that of ALL children with CRLF2 high expression in the intermediate-risk (IR) and high-risk (HR) groups.(P < 0.05).Cox analysis showed that CRLF2 high expression is an independent risk factor for the relapse of children with ALL.Conclusion:The recurrence rate of pediatric ALL with CRLF2 high expression is high,and CRLF2 high expression is an important prognostic factor for high risk of relapse in ALL children with IR and HR.It is necessary to use CRLF2 expression as an indicator of risk stratification in pediatric ALL.