中国当代儿科杂志2009，Vol.11Issue(1)：5-9,5.
儿童急性淋巴细胞白血病早期治疗反应的预后价值:上海儿童医学中心单中心的临床报告
Prognostic value of early treatment response in children with acute lymphoblastic leukemia: a single institution experience in Shanghai, China
摘要
Abstract
Objective Early response to therapy is one of the most important prognostic factors in childhood acute lymphoblastic leukemia(ALL).This study aimed to assess the prognostic value of morphological assessment of bone marrow blasts during remission induction and determination of minimal residual disease(MRD)after remission induction.Methods From January 1998 to May 2003,193 children with newly diagnosed ALL were enrolled on the ALL-XH-99protocol.Blast cell count in the bone marrow was examined on day 19 of remission induction and by the completion of remission induction.MRD was measured with the flow cytometry.Event-free survival(EFS)was estimated by KaplanMeier analysis and the distributions of EFS were compared using the log-rank test.A Cox proportional hazards model was used to identify independent prognostic factors.Results The 4-year EFS was8 significantly worse in patients with≥5%lyrephoblasts in the bone marrow on day 19 as compared to those with＜5%lymphoblasts on that date(42.59%±14.28%vs 74.24%±6.67%;P＜0.01).The 4-year EFS was significantly worse in patients with any amount of lymphoblasts in the bone marrow on the remission date as compared to that of other patients with no morphologieally identifiable blasts(63.47%±9.23%vs 76.41%±6.09%:P＜0.05).the patients with MRD＜0.01 had significantly better outcome than those with a level≥0.01%(15.month EFS:94.44%±5.40%vs 23.81%±20.26%:P＜0.01).Conclusions Early treatment response as assessed by morphological examination or minimal residual leukemia determination by flow cytometry has important prognostic significance,and van be performed in a resource-poor patient population.关键词
白血病,淋巴细胞,急性/微量残留病/幼稚细胞数/预后因素/儿童Key words
Leukemia,lymphoblastic,acute/Minimal residual disease/Lymphoblast count/Prognostic factor/Child分类
医药卫生引用本文复制引用
帖利军,叶辉,陈静,顾龙君,宋得莲,蒋黎敏,薛惠良,汤静燕,董璐,潘慈..儿童急性淋巴细胞白血病早期治疗反应的预后价值:上海儿童医学中心单中心的临床报告[J].中国当代儿科杂志,2009,11(1):5-9,5.基金项目
We thank the International Outreach Program of St.Jude Children's Research Hospital for the support of this study. （）
