Hirase Satoshi, Hasegawa Daiichiro, Takahashi Hironobu, Moriwaki Kensuke, Saito Atsuro, Kozaki Aiko, Ishida Toshiaki, Yanai Tomoko, Kawasaki Keiichiro, Yamamoto Nobuyuki, Kubokawa Ikuko, Mori Takeshi, Hayakawa Akira, Nishimura Noriyuki, Nishio Hisahide, Iijima Kazumoto, Kosaka Yoshiyuki
Department of Pediatrics, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan.
Department of Hematology and Oncology, Kobe Children's Hospital, 1-1-1, Takakuradai, Suma, Kobe, 654-0081, Japan.
Int J Hematol. 2015 Nov;102(5):594-601. doi: 10.1007/s12185-015-1875-0. Epub 2015 Oct 6.
Recent studies have reported that the absolute lymphocyte count (ALC) during induction therapy is predictive of treatment outcome in de novo acute lymphoblastic leukemia (ALL); however, the significance of ALC on outcomes remains controversial. In the present study, we assessed the significance of ALC at day 29 (ALC-29), the end of induction therapy, on outcomes in our Japanese cohort. The outcomes of 141 patients aged ≤18 years with newly diagnosed ALL who were enrolled on the JACLS ALL-02 at our hospitals were analyzed in terms of ALC-29. Patients with ALC-29 ≥750/μL (n = 81) had a superior 5-year EFS (95.2 ± 2.7 vs 84.3 ± 4.8 %, P = 0.016) and OS (100 vs 87.0 ± 4.7 %, P = 0.0062). A multivariate analysis identified ALC-29 ≥750/μL as a significant predictor of improved EFS and OS after controlling for confounding factors. A multiple linear regression model revealed a significant inverse relationship between the percentage of blasts in bone marrow on day 15 and ALC-29 (P = 0.005). These results indicate that ALC is a simple prognostic factor in childhood ALL, and, thus, has the potential to refine current risk algorithms.
近期研究报告称，诱导治疗期间的绝对淋巴细胞计数（ALC）可预测初发急性淋巴细胞白血病（ALL）的治疗结果；然而，ALC对预后的意义仍存在争议。在本研究中，我们评估了诱导治疗结束时第29天的ALC（ALC-29）对我们日本队列患者预后的意义。对在我们医院参加JACLS ALL-02研究的141例年龄≤18岁的新诊断ALL患者的预后，根据ALC-29进行了分析。ALC-29≥750/μL的患者（n = 81）有更好的5年无事件生存率（EFS）（95.2±2.7%对84.3±4.8%，P = 0.016）和总生存率（OS）（100%对87.0±4.7%，P = 0.0062）。多因素分析确定，在控制混杂因素后，ALC-29≥750/μL是EFS和OS改善的显著预测因素。多元线性回归模型显示，第15天骨髓中原始细胞百分比与ALC-29之间存在显著的负相关（P = 0.005）。这些结果表明，ALC是儿童ALL的一个简单预后因素，因此有可能完善当前的风险评估算法。
