De Angulo Guillermo, Yuen Carrie, Palla Shana L, Anderson Peter M, Zweidler-McKay Patrick A
Division of Pediatrics, The University of Texas M. D. Anderson Cancer Center, Houston, Texas 77030-4009, USA.
Cancer. 2008 Jan 15;112(2):407-15. doi: 10.1002/cncr.23168.
Leukemia is the leading cause of disease-related death in children, despite significant improvement in survival and modern risk stratification. The prognostic significance of absolute lymphocyte counts (ALC) was evaluated in young patients with acute myeloblastic leukemia (AML) and acute lymphoblastic leukemia (ALL).
In all, 171 consecutive de novo cases of AML and ALL, age <or=21 years, were analyzed. Age, initial white blood cell count, cytogenetics, and bone marrow response were compared with lymphocyte, neutrophil, and platelet counts at weekly intervals during induction chemotherapy.
ALC is a significant independent predictor of relapse and survival. For example, in patients with AML an ALC on Day 28 of induction (ALC-28) <350 cells/microL predicts very poor survival, with a 5-year relapse-free survival (RFS) of only 10% (hazard ratio [HR] 3.7, P= .003). In contrast, an ALC-15 >350 cells/microL carries an excellent prognosis, with a 5-year overall survival (OS) of 85% (HR 0.2, P= .012). Similarly in ALL, an ALC-15 <350 cells/microL predicts poor survival, with a 6-year RFS of 43% (HR 4.5, P= .002), whereas an ALC-15 >350 cells/microL predicts excellent outcome, with a 6-year OS of 87% (HR 0.2, P= .018). Importantly, ALC remains a strong predictor in multivariate analysis with known prognostic factors.
ALC is a simple, statistically powerful measurement for patients with de novo AML and ALL. The results, when combined with previous studies, demonstrate that ALC is a powerful new prognostic factor for a range of malignancies. These findings suggest a need for further exploration of postchemotherapy immune status and immune-modulating cancer therapies.
尽管儿童白血病患者的生存率有显著提高且现代风险分层取得进展，但白血病仍是儿童疾病相关死亡的主要原因。本研究评估了绝对淋巴细胞计数（ALC）在急性髓系白血病（AML）和急性淋巴细胞白血病（ALL）年轻患者中的预后意义。
共分析了171例年龄≤21岁的初发AML和ALL连续病例。在诱导化疗期间，每周对年龄、初始白细胞计数、细胞遗传学和骨髓反应与淋巴细胞、中性粒细胞和血小板计数进行比较。
ALC是复发和生存的重要独立预测因素。例如，在AML患者中，诱导第28天的ALC（ALC-28）<350个细胞/微升预示生存极差，5年无复发生存率（RFS）仅为10%（风险比[HR] 3.7，P = .003）。相反，诱导第15天的ALC（ALC-15）>350个细胞/微升预后极佳，5年总生存率（OS）为85%（HR 0.2，P = .012）。同样在ALL中，ALC-15<350个细胞/微升预示生存较差，6年RFS为43%（HR 4.5，P = .002），而ALC-15>350个细胞/微升预示预后极佳，6年OS为87%（HR 0.2，P = .018）。重要的是，在多因素分析中，ALC与已知预后因素相比仍是一个强有力的预测因素。
ALC是初发AML和ALL患者一种简单且具有统计学效力的指标。结合既往研究结果表明，ALC是一系列恶性肿瘤强有力的新预后因素。这些发现提示需要进一步探索化疗后免疫状态及免疫调节性癌症治疗。
