四川医学2018，Vol.39Issue(5)：512-518,7.DOI:10.16252/j.cnki.issn1004-0501-2018.05.010
儿童急性淋巴细胞白血病长期随访生存分析
Long-Term Follow-Up and Analysis of Childhood Acute Lymphoblastic Leukemia
李丹 1史宏 1贺钰磊 1高钰 1徐倩 1夏忆 1金盛娴 1张庆 1李蕙 1周敏1
作者信息
- 1. 成都市妇女儿童中心医院儿内科,四川 成都610091
- 折叠
摘要
Abstract
Objective To investigate the effect of diagnosis and treatment of childhood acute lymphoblastic leukemia ( ALL) on prognosis and to improve the level of diagnosis and treatment. Methods Collect 114 children patients with first visit ALL from June 2005 to December 2016,and make retrospective analysis on different chemotherapy regimens,risk grouping,whether there were complete MICM diagnosis,whether there were minimal residual disease( MRD) monitoring,whether induction chemo-therapies were conventional,and the effect of whether continued chemotherapy delayed after induction on 5-year event-free survival ( EFS) ,and COX proportional hazards regression model was used to analyze the factors affecting prognosis. Results The 5-year EPS of patients in 08 treatment group was(80. 3 ± 5. 9)%,higher than 06 treatment group(51. 9 ± 9. 6)% and 05 treatment group(45. 0 ± 11. 1)%,and the difference was significant( =7. 23,P=0. 007; =5. 58,P=0. 018). The 5-year EFS of high risk group was (19.9 ±12.4)%,lower than standard risk group(70.8% ±8.9%)and medium risk group(67.0% ±6.9%),and the difference was statistically significant( =8. 938,P=0. 003; =9. 365,P=0. 002). The 5-year EFS of patients with MRD monitoring was (80. 2 ± 5. 9)%,higher than patients without MRD monitoring(46. 7 ± 7. 3)%,and the difference was statistically significant( =11. 568,P=0. 001). The 5-year EFS of the patients with nonstandard induction chemotherapy were(32. 8 ± 12. 2)%,less than standard induction chemotherapy patients(72. 1 ± 5. 2)%,and the difference was statistically significant( =8. 886,P=0. 003). Patients with delayed chemotherapy after induction had no statistically significant difference between the 5-year EFS of the patients without delay( =1. 806,P=0. 179). There was no statistically significant difference of 5-year EFS between the patients with in-complete MICM diagnosis and the patients with complete MICM diagnosis( =3. 37,P=0. 66). Multivariate risk analysis showed that high risk degree in risk grouping,no MRD monitoring,and nonstandard induction chemotherapy were the risk factors for children ALL patients with poor prognosis. Conclusion The risk grouping and standardization of induction therapy and the adjustment of treatment intensity according to MRD are important factors affecting the prognosis of children ALL patients. The diagnosis,monitoring and standardization based on cytogenetics and molecular biological level are the effective means to improve survival.关键词
急性淋巴细胞白血病/儿童/诊断/治疗/预后Key words
acute lymphoblastic leukemia/child/diagnosis/treatment/prognosis分类
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李丹,史宏,贺钰磊,高钰,徐倩,夏忆,金盛娴,张庆,李蕙,周敏..儿童急性淋巴细胞白血病长期随访生存分析[J].四川医学,2018,39(5):512-518,7.
