ALL患儿CCCG-ALL 2015方案化疗后早期微小残留病与预后的关系

Relationship of Minimal Residual Disease in Children with ALL in Early Stage after Chemotherapy with CCCG-ALL 2015 Regimen with the Prognosis

目的探讨急性淋巴细胞白血病(ALL)患儿儿童肿瘤协作组(CCCG)-ALL 2015方案化疗后早期微小残留病(MRD)检测及与预后的关系。方法回顾性分析2017年6月—2019年12月收治的ALL患儿102例的临床资料,均采用CCCG-ALL 2015方案化疗,记录化疗后早期MRD发生情况,并探讨其与预后的关系。结果随访3个月,3组在第15、33天MRD阴性率比较差异无统计学意义(P>0.05),但在第90天,3组间MRD阴性率比较差异有统计学意义(P<0.05)。随访3年,102例3年总生存率为90.20%,3年无事件生存率为83.33%。经多因素Logistic回归分析发现,危险度分层高危、白细胞计数>50×10^(9)/L、33 d MRD≥1%、90 d MRD≥0.1%是影响ALL患儿3年OS及EFS的独立危险因素(P<0.05)。结论ALL患儿在应用CCCG-ALL 2015方案化疗后对MRD进行动态监测十分关键,33 d及90 d MRD水平是提示预后的敏感指标。

Objective To investigate the detection of minimal residual disease(MRD)in children with acute lymphoblastic leukemia(ALL)in early stage after chemotherapy with the Chinese Children's Cancer Group ALL 2015(CCCG-ALL 2015)regimen,and its relationship with the prognosis.Methods The clinical data of 102 children with ALL who were admitted to the hospital from June 2017 to December 2019 were retrospectively analyzed.All children underwent chemotherapy with CCCG-ALL 2015 regimen.The occurrence of MRD in early stage after chemotherapy was recorded,and its relationship with prognosis was analyzed.Results After 3 months of follow-up,there was no significant difference in MRD negative rate among the three groups on the 15th and 33rd day(P>0.05),but there was significant difference in MRD negative rate among the three groups on the 90th day(P<0.05).After 3-year follow-up,the 3-year overall survival rate(OS)and 3-year event-free survival rate(EFS)of 102 patients were 90.20%and 83.33%respectively.Multivariate Logistic regression analysis showed that high risk based on risk stratification,white blood cell count(WBC)>50×10^(9)/L,MRD at day 33≥1%,MRD at day 90≥0.1%were independent risk factors affecting 3-year OS and EFS in children with ALL(P<0.05).Conclusion Dynamic monitoring of MRD in children with ALL after chemotherapy with CCCG-ALL 2015 regimen is very important.MRD at day 33 and 90 is a sensitive indicator of prognosis.