初诊儿童急性淋巴细胞白血病治疗相关死亡的危险因素的分析

Effect of the Risk Factors for Treatment-Related Death in Children with Acute Lymphoblastic Leukemia

目的:探讨儿童急性淋巴细胞白血病(acute lymphoblastic leukemia,ALL)患儿接受治疗后发生死亡的可能危险因素。方法:回顾性分析2016年1月1日至2019年12月31日在武汉儿童医院血液肿瘤科初诊且接受治疗后死亡的31例ALL患儿的临床资料,对ALL患儿各项观察指标行单因素分析及多因素Cox回归分析,并分析ALL患儿接受治疗后死亡的可能危险因素。结果:共有230例初诊ALL患儿接受治疗,31例死亡(13.4%),其中男12例,女19例。不同性别的死亡率分别为9%(12/133)、19.5%(19/97)(P=0.02);死亡患儿中,年龄<1岁6例,1-10岁23例,>10岁2例,不同年龄组死亡率分别为46.1%(6/13)、11.7%(23/195)和9%(2/22)(P=0.00);标危组、中危组、高危组的死亡率分别为6.7%(4/59)、11.9%(13/109)、22.5%(14/62)(P=0.03);初诊时WBC<50×10^9/L、(50-100)×10^9/L、>100×10^9/L患儿的死亡率分别为11%(22/199)、30%(3/10)和28.5%(6/21)(P=0.03);融合基因正常的患儿死亡率为11%(17/154),TEL/AML、BCR/ABL及KMT2A重排患儿的死亡率分别为13.8%(5/36)、20%(2/10)及50%(5/10)(P=0.00)。以上差异均有统计学意义。B-ALL与T-ALL患儿死亡率分别为13%(28/214)和18.7%(3/16)(P=0.54)。多因素分析显示,性别(P=0.03)、年龄(P=0.00)、初诊白细胞数(P=0.05)是影响患儿死亡率的危险因素。结论:女性、初诊时年龄<1岁、高危ALL、初诊WBC>50×109/L、伴有融合基因BCR/ABL及KMT2A重排阳性是儿童ALL接受治疗后发生死亡的可能危险因素。

Objective:To explore the possible risk factors of death in children with acute lymphoblastic leukemia(ALL)after treatment.Methods:The clinical data of 31 children with newly diagnosed acute lymphoblastic leukemia and dead after treatment in the Hematology Oncology Department of Wuhan children's Hospital from January 1,2016 to December 31,2019 were retrospectively analyzed.Univariate factor analysis and multivariate Cox regression analysis were used to analyze the each indexes of ALL children,and the possible risk factors causes of death in ALL children after treatment were analyzed.Results:Among 230 newly diagnosed ALL children,31(13.4%)cases were dead.Among them,there were 12 male and 19 female.The mortality rates were 9%(12/133)for male and 19.5%(19/97)for female,which showed a significantly difference(P=0.02);among the dead ALL children,6 were less than 1 year old,23 were 1-10 years old,and 2 was more than 10 years old.The mortality rates in different age groups were 46.1%(6/13),11.7%(23/195)and 9%(2/22),respectively,which showed a significantly difference(P=0.00);the mortality rates of the ALL children in standard risk group,medium risk group and high risk group were 6.7%(4/59),11.9%(13/109)and 22.5%(14/62),respectively,which showed a significantly difference(P=0.03).The mortality rates of ALL children with WBC<50×10^9/L,50-100×10^9/L,and>100×10^9/L were 11%(22/199),30%(3/10)and 28.5%(6/21),respectively,which showed a significantly difference(P=0.03);the mortality rate of ALL children with normal fusion gene was 11%(17/154),and for All children with TEL/AML,BCR/ABL and KMT2A rearrangement was 13.8%(5/36),20%(2/10)and 50%(5/10),respectively(P=0.00).The mortality rates of children with B-ALL and T-ALL were 13%(28/214)and 18.7%(3/16),respectively(P=0.54).The results of multivariate analysis showed that sex(P=0.03),age(P=0.00),and white blood cell count(P=0.05)were the risk factors of mortality.Conclusion:The female,less than 1 year old at initial diagnosis,high risk ALL,WBC>50×109/L,BCR/ABL and KMT2A rearrangement are the possible risk factors causes of death in children after treatment.