Viana M B, Murao M, Ramos G, Oliveira H M, de Carvalho R I, de Bastos M, Colosimo E A, Silvestrini W S
Department of Paediatrics, Federal University of Minas Gerais, Brazil.
Arch Dis Child. 1994 Oct;71(4):304-10. doi: 10.1136/adc.71.4.304.
One hundred and twenty eight Brazilian children with lymphoblastic leukaemia were intensively treated with a Berlin-Frankfurt-Munich based protocol. More children had a white cell count above 50 x 10(9)/l (31%) then observed in developed countries. After a median follow up of 31 months (11-58 months), the estimated probability of relapse free survival was 41% (7%) for the whole group. After adjustment in the Cox's multivariate model, malnutrition was the most significant adverse factor affecting duration of complete remission. Age above 8 years and high peripheral white cell count were also significant adverse factors. Among the nutritional indices, the height for age and weight for age z scores were both significant, whether the cut off points of z-2 or z = -1.28 were chosen to define malnutrition. A strong statistical association between the two indices was found; the contribution of height for age z score to the prediction of relapse free survival was more significant. Children with height for age z score < -2 had a relapse risk of 8.2 (95% confidence interval 3.1 to 21.9) relative to children with z score > -2. The results of this study suggest that socioeconomic and nutritional factors should be considered in the prognostic evaluation of children with leukaemia in developing countries.
128名患有淋巴细胞白血病的巴西儿童接受了基于柏林-法兰克福-慕尼黑方案的强化治疗。与发达国家相比，更多儿童的白细胞计数高于50×10⁹/L（31%）。中位随访31个月（11 - 58个月）后，整个组无复发生存的估计概率为41%（7%）。在Cox多变量模型调整后，营养不良是影响完全缓解持续时间的最显著不利因素。8岁以上年龄和高外周白细胞计数也是显著的不利因素。在营养指标中，无论选择z=-2还是z = -1.28作为定义营养不良的切点，年龄别身高和年龄别体重z评分均具有显著性。发现这两个指标之间存在很强的统计学关联；年龄别身高z评分对无复发生存预测的贡献更显著。年龄别身高z评分＜-2的儿童相对于z评分＞-2的儿童复发风险为8.2（95%置信区间3.1至21.9）。本研究结果表明，在发展中国家白血病儿童的预后评估中应考虑社会经济和营养因素。
