Department of Laboratory Medicine, West China Second University Hospital, Sichuan University.
Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, Sichuan, China.
Medicine (Baltimore). 2021 Jan 29;100(4):e24518. doi: 10.1097/MD.0000000000024518.
Peripheral blood (PB) blast cell count on day 8 of prednisone therapy has been considered one of the strongest predictors of outcome in children with acute lymphoblastic leukemia (ALL). However, little is known about the clinical features and prognostic impact of PB blast cell count at diagnosis in these patients. The aim of this study was to evaluate the relationship between initial PB blast cell count and clinical prognosis of pediatric ALL.The study comprised 367 patients with ALL, aged 0 to 14 years, enrolled and treated using the Chinese Children's Leukemia Group-ALL 2008 protocol between 2011 and 2015. The majority (91.6%) of patients were B-cell precursor ALL (BCP ALL), and 8.4% were T-cell ALL (T-ALL).Patients with BCP ALL in the low PB blast cell count group (<1 × 109/L) had significantly superior survival rates to those in the high count group (≥30 × 109/L). In T-ALL, the low count group showed significantly inferior survival rates compared to both the intermediate count group (1-29.9 × 109/L) and high count group. Multivariate analysis revealed that the initial white blood cell count and minimal residual disease at the end of induction therapy were independently predictive of BCP ALL outcome, while risk stratification was shown to be an independent prognostic factor for T-ALL outcome.These results indicated that low blast cell count in PB at diagnosis was associated with different clinical outcomes in patients with BCP ALL and T-ALL, although it was not an independent outcome predictor by multivariate analysis.
在泼尼松治疗的第 8 天外周血（PB）blasts 细胞计数被认为是儿童急性淋巴细胞白血病（ALL）预后的最强预测因素之一。然而，关于这些患者诊断时 PBblasts 细胞计数的临床特征和预后影响知之甚少。本研究旨在评估初始 PBblasts 细胞计数与儿科 ALL 临床预后之间的关系。
该研究纳入了 2011 年至 2015 年期间使用中国儿童白血病组 ALL2008 方案治疗的 367 例年龄 0 至 14 岁的 ALL 患儿。大多数（91.6%）患者为 B 细胞前体 ALL（BCP ALL），8.4%为 T 细胞 ALL（T-ALL）。BCP ALL 低 PBblasts 细胞计数组（<1×109/L）患者的生存率明显优于高计数组（≥30×109/L）。在 T-ALL 中，低计数组的生存率明显低于中计数组（1-29.9×109/L）和高计数组。多变量分析显示，诱导治疗结束时的初始白细胞计数和微小残留病是 BCP ALL 结局的独立预测因素，而风险分层被证明是 T-ALL 结局的独立预后因素。
这些结果表明，诊断时 PB 中低blasts 细胞计数与 BCP ALL 和 T-ALL 患者的不同临床结局相关，尽管多变量分析显示其不是独立的预后预测因素。
