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目的在儿童急性淋巴细胞白血病(ALL)治疗中,早期治疗反应是最重要的预后因素之一。该文评价了诱导治疗第19天及血液学完全缓解时骨髓存在形态学可辨认的幼稚淋巴细胞数及微量残留病(MRD)监测在儿童ALL治疗中的预后价值。方法1998年1月至2003年5月接受ALL-XH-99方案治疗的193例新诊治的ALL患儿为研究对象。联合化疗第19天及诱导缓解治疗结束时行骨髓形态学检查以及血液学缓解时用四色MP-FCM检测MRD。生存分析采用Kaplan-Meier方法,各组无事生存率(EFS)之间的比较采用log-rank检验,各生物学特征的比较采用χ2检验或Fisher确切概率法(双尾),COX风险比例模型用于评估预后因素。结果①诱导治疗第19天骨髓幼稚淋巴细胞≥5%与<5%的患儿4年EFS差异有非常显著性意义(42.59%±14.28%vs74.24%±6.67%;P<0.01);②诱导缓解治疗结束达血液学缓解时存在形态学可识别的幼稚淋巴细胞(幼稚淋巴细胞>0%)与此时无形态学可辨认的幼稚淋巴细胞的患儿4年EFS差异有显著性意义(63.47%±9.23%vs76.41%±6.09%;P<0.05);③诱导缓解治疗结束血液学完全缓解时MRD≥0.01%与MRD<0.01%的患儿15月EFS差异有非常显著性意义(23.81%±20.26%vs94.44%±5.40%;P<0.01)。结论诱导治疗第19天骨髓幼稚细胞数≥5%、诱导治疗结束血液学缓解时骨髓幼稚细胞>0%及MRD监测在儿童急性淋巴细胞白血病治疗中具有预后价值,可用于发展中国家儿童ALL早期治疗反应的评估。
OBJECTIVE: Early treatment response in childhood acute lymphoblastic leukemia (ALL) is one of the most important prognostic factors. This article evaluated the prognostic value of childhood lymphocyte count and trace residual disease (MRD) monitoring on bone marrow presence morphology at day 19 of induction therapy and complete remission of hematology in pediatric ALL therapy. Methods A total of 193 newly diagnosed ALL children undergoing ALL-XH-99 regimen from January 1998 to May 2003 were enrolled in this study. MRD was detected by four-color MP-FCM at day 19 of combination chemotherapy and at the end of induction remission with myeloproliferation and hematologic remission. The Kaplan-Meier method was used for survival analysis. The log-rank test was used to compare the EFS. The biological characteristics were compared using Chi-square test or Fisher exact test (two-tailed), COX risk proportional model Used to assess prognostic factors. Results ① There was significant difference in 4-year EFS between children with ≥5% and <5% lymphocytes on the 19th day after induction therapy (42.59% ± 14.28% vs74.24% ± 6.67%; P <0.01) There was a significant difference in 4-year EFS in children with morphologically identifiable naïve lymphocytes (naive lymphocytes> 0%) at the end of induction remission at hematologic remission 63.47% ± 9.23% vs76.41% ± 6.09%; P <0.05). ③The difference of 15-month EFS in children with MRD≥0.01% and MRD <0.01% at the end of induction hematology complete remission was very significant 23.81% ± 20.26% vs94.44% ± 5.40%; P <0.01). CONCLUSION: Bone marrow naive cells ≥5% on induction treatment day 19, bone marrow blasts> 0% at the end of induction therapy and MRD monitoring have prognostic value in the treatment of children with acute lymphoblastic leukemia and can be used in the early stage of childhood ALL in developing countries Assessment of treatment response.