Yu Jieming, Yi Tiantian, Lin Guanchuan, Wen Jianyun, Chen Libai, Chen Jiaqi, Wu Xuedong
Department of Pediatrics, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China.
Affiliated Shenzhen Maternity and Child Healthcare Hospital, Southern Medical University, Shenzhen 518028, China.
Nan Fang Yi Ke Da Xue Xue Bao. 2020 Feb 29;40(2):255-261. doi: 10.12122/j.issn.1673-4254.2020.02.18.
To assess the prognostic value of minimal residual disease on 19th day of induction chemotherapy (D19 MRD) and the risk factors of D19 MRD ≥ 1% in children with acute lymphoblastic leukemia (ALL) treated following the Chinese Children's Cancer Group ALL protocol.
We retrospectively analyzed the data of 243 children with ALL diagnosed between January 1, 2015 and December 31, 2018 in the Department of Pediatrics of Nanfang Hospital (Guangzhou China). Kaplan Meier-survival analysis was performed to compare the survival time between the patients with D19 MRD < 1% and those with D19 MRD ≥ 1%; logistic regression analyisis and Chi-square test were used to identify the risk factors of D19 MRD ≥ 1%.
Compared with those with D19 MRD ≥ 1%, the children with D19 MRD < 1% had significantly better 3-year overall survival (100% 90.2%, =0.004) and event-free survival (97.6% 71.6%, < 0.001). Univariate analysis showed that the odds ratio (OR) for mediastinal invasion, T-cell immunophenotype, TEL/AML1 fusion gene and the presence of blasts in peripheral blood on the 5th day were 4.47 (95%: 0.275-72.968, =0.034), 5.250 (95%: 1.950-14.133, =0.02), 0.330 (95%: 0.112-0.970, =0.036) and 4.407 (95%: 1.782-10.895, =0.01), respectively. The initial risk stratification ( < 0.001), white blood cell grades (=0.018) and its counts (=0.027), and the number of blasts on the 5th day ( < 0.001) were significantly different between the two groups. Multivariate analysis showed that initial risk stratification as intermediate and high risks (OR=2.889, 95% : 1.193-6.996) and the presence of blasts in peripheral blood on the 5th day (OR=4.477, 95% : 1.692-11.843) were independent risk factors for poor early treatment response.
D19 MRD ≥ 1% is a predictor of poor prognosis in children with ALL. Mediastinal invasion, T-cell immunophenotype and the presence of blasts in peripheral blood on the 5th day are all risk factors for poor early treatment response, while TEL/AML1 fusion gene is a protective factor; the initial risk stratification as intermediate to high risk and the presence of blasts in peripheral blood on the 5th day are independent risk factors for poor early treatment response of the patients.
评估按照中国儿童癌症协作组急性淋巴细胞白血病（ALL）方案治疗的儿童，诱导化疗第19天微小残留病（D19 MRD）的预后价值以及D19 MRD≥1%的危险因素。
我们回顾性分析了2015年1月1日至2018年12月31日期间在南方医院（中国广州）儿科确诊的243例ALL患儿的数据。采用Kaplan Meier生存分析比较D19 MRD<1%和D19 MRD≥1%患者的生存时间；使用逻辑回归分析和卡方检验确定D19 MRD≥1%的危险因素。
与D19 MRD≥1%的患儿相比，D19 MRD<1%的患儿3年总生存率（100%对90.2%，P=0.004）和无事件生存率（97.6%对71.6%，P<0.0
