Jiang Meng-Ying, Gao Wei, Gao Jing, Ling Jing, Pan Jian, Xiao Pei-Fang, Lu Jun, He Hai-Long, Wang Yi, Li Jie, Li Jian-Qin, Chai Yi-Huan, Sun Yi-Na, Hu Shao-Yan
Department of Hematology, Children's Hospital of Soochow University , Suzhou 215025, Jiangsu Province, China.
Department of Hematology, Children's Hospital of Soochow University , Suzhou 215025, Jiangsu Province, China,E-mail:
Zhongguo Shi Yan Xue Ye Xue Za Zhi. 2022 Feb;30(1):12-17. doi: 10.19746/j.cnki.issn.1009-2137.2022.01.003.
To analyze the efficacy of children with B-cell acute lymphoblastic leukemia (B-ALL) without prognostic fusion genes treated by CCLG-ALL 2008, and investigate the related factors affecting the recurrence of the patients.
B-ALL patients without prognostic fusion genes treated by the protocol of CCLG-ALL 2008 in our hospital from March 2008 to December 2012 were retrospectively analyzed. Follow-up time was ended in August 31, 2019. The median follow-up time was 92 months (range 0-136 months). Kaplan-Meier was used to detect the RFS, and COX multivariate regression analysis was employed to identify the independent factors affecting the recurrence of the patients.
There were 140 males and 99 females enrolled in this study. The ratio of male to female was 1.41∶1. The median age was 4.4 years old and the median number of WBC at initial stage was 4.98×10/L. There were 77 cases relapsed during the observation while 162 without relapsed, 16 cases lost to follow-up and 72 cases died. The recurrence and mortality rate was 32.22% and 30.1%, respectively, in which 45 cases died of recurrence (62.5% of the total deaths). Univariate analysis showed that the age≥6 years old, WBC >100×10/L, the bone marrow blasts on day 15≥25%, the bone marrow minimal residual disease (MRD) at week 12 >10, and the higher risk were the main factors affecting the recurrence of the patients (P<0.05). Multivariate COX regression analysis showed that age≥6 years old, WBC >100×10/L, bone marrow MRD >10 at the 12th week were the independent risk factors affecting recurrence of the patients.
Age, initial WBC, and bone marrow MRD at the 12th week were correlated with recurrence in children with B-ALL without prognostic fusion genes, which can be used as prognostic indices of recurrence risk in clinical.
分析采用CCLG-ALL 2008方案治疗的无预后融合基因的B淋巴细胞白血病（B-ALL）患儿的疗效，并探讨影响患儿复发的相关因素。
回顾性分析2008年3月至2012年12月在我院采用CCLG-ALL 2008方案治疗的无预后融合基因的B-ALL患儿。随访至2019年8月31日结束。中位随访时间为92个月（范围0-136个月）。采用Kaplan-Meier法检测无事件生存期（RFS），并采用COX多因素回归分析确定影响患儿复发的独立因素。
本研究共纳入140例男性和99例女性。男女比例为1.41∶1。中位年龄为4.4岁，初诊时白细胞中位数为4.98×10/L。观察期间有77例复发，162例未复发，16例失访，72例死亡。复发率和死亡率分别为32.22%和30.1%，其中45例死于复发（占总死亡人数的62.5%）。单因素分析显示，年龄≥6岁、白细胞>100×10/L、第15天骨髓原始细胞≥25%、第12周骨髓微小残留病（MRD）>10以及高危是影响患儿复发的主要因素（P<0.05）。多因素COX回归分析显示，年龄≥6岁、白细胞>100×10/L、第12周骨髓MRD>10是影响患儿复发的独立危险因素。
年龄、初诊白细胞及第12周骨髓MRD与无预后融合基因的B-ALL患儿的复发相关，可作为临床复发风险的预后指标。
