小儿T系急性淋巴细胞白血病的临床预后分析

Clinical prognosis of T cell acute lymphoblastic leukemia in children

目的T系急性淋巴细胞白血病(T-ALL)属于小儿少见且高度恶性的肿瘤性疾病,研究其预后因素及临床特点,为临床带来一定的参考价值。方法回顾性分析南京医科大学附属淮安第一医院收治的54例T-ALL患儿的临床资料,所有患儿均采用上海儿童医学中心SCMC-ALL-2009化疗方案。统计分析研究对象的病史、实验室检查报告、影像学资料、预后情况等。采用Kaplan-Meier方法分析。结果54例患儿的中位生存时间为43.5个月,2个疗程后的完全缓解率为90.74%,3年总生存率和无病生存率分别为81.48%和77.78%,其中24例(44.44%)初诊时伴有纵隔占位。54例中有10例(18.51%)死亡,其中6例(11.11%)死于复发。单因素分析结果显示:年龄、性别、初诊白细胞数、D19是否缓解、D35是否缓解、初诊乳酸脱氢酶、纵隔占位、脾浸润、门冬酰胺酶总量是否足量对3年OS均有统计学意义(P<0.001);多因素分析显示年龄(P=0.004)、D35骨髓是否缓解(P<0.001)、D35 MRD(P<0.001)、LDH(P=0.019)是影响患者3年总生存率的独立危险因素。结论SCMC-ALL-2009方案对小儿T系急性淋巴细胞白血病的总体疗效较好,少数患儿死亡主要是疾病复发,初诊时乳酸脱氢酶、年龄及D35缓解情况是独立危险因素。

Objective T cell acute lymphoblastic leukemia(T-ALL)is a rare and highly malignant neoplastic disease in children.The study of its prognostic factors and clinical characteristics will bring certain reference value to the clinic.Methods The clinical data of 54 children with T-ALL admitted to Huai′an First Hospitalwere retrospectively analyzed.All children were treated with Shanghai Children′s Medical Center-Acute Lymphoblastic Leukemia-2009(SCMC-ALL-2009)chemotherapy program.The medical history,laboratory examination report,imaging data and prognosis of the subjects were statistically analyzed.Kaplan-Meiermethod was used for survival analysis.Results The median survival time of the 54 children was 43.5 months.The complete remission rate after 2 courses of chemotherapy was 90.74%.And the 3-year overall survival and disease-free survivalrates were 81.48%and 77.78%,respectively,of which 24(44.44%)had mediastinal mass at the initial diagnosis.Of the 54 cases,10 cases(18.51%)died,of which 6 cases(11.11%)died of recurrence.The results of univariate analysis showed that age,gender,white blood cell count at the first diagnosis,whether D19 remission,D35 remission,newly diagnosed level of lactate dehydrogenase,mediastinal mass,spleen infiltration,and the sufficient amount of asparaginase were statistically significant for 3-year OS(P<0.001).Multivariate analysis showed that age(P=0.004),whether D19 remission(P<0.001),D35 MRD(P<0.001)and LDH(P=0.019)were independent risk factors affecting the 3-year overall survival rate.Conclusion SCMC-ALL-2009regimen has a good overall effect on T cell acute lymphoma,and recurrence is the main cause of death in a few children.Lactate dehydrogenase(at initial diagnosis),age and D35 remission were independent risk factors.