Department of Pediatrics, Peking University People's Hospital, Peking University, Beijing, China.
Department of Pediatrics, Peking University People's Hospital, Peking University, Beijing, China.
Clin Lymphoma Myeloma Leuk. 2023 Jul;23(7):477-483. doi: 10.1016/j.clml.2023.03.013. Epub 2023 Mar 29.
Pediatric T-cell acute lymphoblastic leukemia (T-ALL) has historically been associated with a poor prognosis. However, prognostic indicators and methods of treatment used for T-ALL remain controversial. A total of 136 children newly diagnosed with T-ALL between 2005 and 2018 were consecutively enrolled in this study. We assessed the effect of different prognostic factors, such as clinical characteristics, minimal residual disease (MRD), and the role of transplantation in postremission treatment, as the outcomes. Compared with B-ALL patients, patients with T-ALL are generally older, more likely to be male and have a higher white blood cell count. The complete remission (CR) rate was 95.6%, while the 5-year overall survival (OS), event-free survival (EFS), and cumulative incidence of relapse (CIR) were 74.3 ± 3.7%, 71.3 ± 3.9%, and 24.4 ± 3.8%, respectively. In the multivariate analysis, day 33 MRD ≥0.1% and hyperleukocytosis were associated with a significantly worse prognosis in the whole group. Transplantation resulted in a significant survival advantage, compared with chemotherapy, for high-risk (HR) patients (5-year CIR: 15.6 ± 10.2% vs. 55.6 ± 11.7%, P = .029). The prognosis of children with T-ALL was poor, and the MRD on day 33 was found to be an important predictive factor of clinical outcome at our center.
儿童 T 细胞急性淋巴细胞白血病（T-ALL）在历史上与预后不良有关。然而，用于 T-ALL 的预后指标和治疗方法仍存在争议。本研究连续纳入了 2005 年至 2018 年间新诊断为 T-ALL 的 136 例儿童患者。我们评估了不同预后因素的影响，例如临床特征、微小残留病（MRD）以及移植在缓解后治疗中的作用。与 B-ALL 患者相比，T-ALL 患者通常年龄较大，男性比例较高，白细胞计数较高。完全缓解（CR）率为 95.6%，5 年总生存率（OS）、无事件生存率（EFS）和累积复发率（CIR）分别为 74.3±3.7%、71.3±3.9%和 24.4±3.8%。多因素分析显示，第 33 天 MRD≥0.1%和白细胞增多与全组患者预后显著相关。与化疗相比，移植对高危（HR）患者具有显著的生存优势（5 年 CIR：15.6±10.2% vs. 55.6±11.7%，P=0.029）。本中心的研究结果显示，T-ALL 患儿预后较差，第 33 天的 MRD 是预测临床结局的重要指标。
