急性淋巴细胞白血病高危组患儿临床特点和预后因素分析

发布时间：2018-01-28 17:18

  本文关键词： 急性淋巴细胞白血病 儿童 高危组 临床特点 预后因素　出处：《中国实验血液学杂志》2017年02期 　论文类型：期刊论文

【摘要】：目的:探讨急性淋巴细胞白血病(ALL)高危组患儿的临床特点和预后因素。方法:2008年8月至2013年3月在苏州大学附属儿童医院就诊的初诊ALL患儿共421例,均采用中国儿童白血病协作组(CCLG)-2008-ALL方案危险分层并治疗,其中标危组148例,中危组191例,回顾性分析高危组82例患儿的临床特点、预期5年概率无事件生存(pEFS)率及总生存(pOS)率。结果:82例病人中位随访时间64(3.0-76.3)个月;诱导化疗1个疗程后达完全缓解55例(缓解率67.1%),复发25例(30.5%)[以早中期复发为主,与标危组差异有统计学意义(P=0.013)],死亡27例(32.9%);5年pEFS率及pOS率分别为57.20%和58.50%。单因素分析显示,Ph~+或BCR/ABL~+和第33天MRD10~(-2)两项因素对EFS和OS影响均有统计学意义(P0.05);多因素COX回归分析显示,Ph~+或BCR/ABL~+具有独立预后意义,第33天MRD因素差异无统计学意义。结论:ALL高危组患儿具有诱导缓解率低、复发率高和5年pEFS率低的临床特点;存在有Ph~+或BCR/ABL~+是其预后差的独立因素。
[Abstract]:Objective: to study ALL in acute lymphoblastic leukemia (ALL). Methods: from August 2008 to March 2013, 421 patients with ALL were admitted to the affiliated Children's Hospital of Suzhou University. All of them were treated with CCLGG-2008-ALL risk stratification and treatment. 148 cases in the bid group and 191 cases in the middle risk group. The clinical features of 82 children in high-risk group were analyzed retrospectively. Results the median follow-up time of 82 patients was 643.0-76.3 months. 55 cases of complete remission after one course of induced chemotherapy (remission rate 67.1%, recurrence 25 cases 30.5%). [The recurrence was mainly early and middle stage, and the difference between the two groups was statistically significant (P < 0.013), and 27 cases died (32. 9%). The pEFS rate and pOS rate in 5 years were 57.20% and 58.50, respectively. Two factors, Phor BCR / ABL ~ and 33rd day MRD10 / 2, had significant effects on EFS and OS (P 0.05). Multivariate COX regression analysis showed that COX or BCR / ABL ~ had independent prognostic significance. There was no significant difference in the factors of MRD on the 33rd day. Conclusion the children in the high risk group of 1: all have the characteristics of low induced remission rate, high recurrence rate and low pEFS rate in 5 years. The existence of Ph- or BCR / ABL ~ is an independent factor for poor prognosis.
【作者单位】： 苏州大学附属儿童医院血液科;上海交通大学附属第六人民医院南院血液科;
【基金】：国家卫生和计划生育委员会科研基金项目(W01301)
【分类号】：R733.71
【正文快照】： 急性淋巴细胞白血病(ALL)是儿童时期最常见的恶性疾病,随着对儿童ALL临床分型标准的不断完善、分型治疗方案及具体化疗方案细节的不断改进,其5年无事件生存(EFS)率已达80%,标危型 ALL患儿治愈率更达到90%以上[1]。然而,有一项或多项危险因素的高危型ALL患儿仍存在较高的复发，

本文编号：1471091