中国循证儿科杂志2024，Vol.19Issue(3)：179-182,4.DOI:10.3969/j.issn.1673-5501.2024.03.003
定期监测微小残留病变对儿童急性淋巴细胞白血病的预后价值
Significance of minimal residual disease in monitoring recurrence of pediatric acute lymphoblastic leukemia
顿建新 1丁玉亭 1张艾 1王雅琴 1刘爱国 1胡群1
作者信息
- 1. 华中科技大学同济医学院附属同济医院儿童血液科 武汉,430030
- 折叠
摘要
Abstract
Background Minimal residual disease(MRD)is used to monitor and assess the treatment response in pediatric acute lymphoblastic leukemia(ALL)and to stratify risk based on MRD levels.Objective To investigate the prognostic value of regularly monitoring MRD during and after chemotherapy in predicting relapse in children with ALL.Design Retrospective cohort study Methods The clinical data of 224 ALL children received CCCG-ALL2015 chemotherapy from January 2015 to February 2020 were retrospectively included in our study.MRD was detected using flow cytometry to analyze the association between regular monitoring of MRD and prediction of recurrence.Main outcome measures Recurrence free survival(RFS)Results A total of 224 children were included in this analysis,with 134 males and 90 females,and a median age of 4.8 years.On day 19(D19)of induction remission,104 cases(46.4%)were MRD-positive,and on day 46(D46),23 cases(10.3%)were MRD-positive.From post-induction remission(week 16)to the end of chemotherapy(week 125),145 cases remained MRD-negative.During follow-up after the end of chemotherapy(weeks 152-287),13 cases became MRD-positive,of which 11(84.6%)relapsed.A total of 28 children relapsed,with a median relapse time of 33 months.Among them,14 survived,12 died,and 2 were lost to follow-up.There were 20 cases of bone marrow relapse,including 2 with concurrent testicular relapse and 1 with CNSL and 8 with CNSL alone.The median follow-up time for the 224 children was 52 months(IQR:36.5-69.5 months),and the 5-year RFS was(84.5±2.8)%.There were statistically significant differences in the 5-year RFS between children with D46 MRD≥0.01%and＜0.01%,as well as between those who remained MRD-negative throughout chemotherapy and those who were MRD-positive at least once(P＜0.05).Conclusion Children with D46 MRD≥0.01%and those who were MRD-positive at least once during chemotherapy had a poorer prognosis.Regular MRD monitoring during chemotherapy is crucial.关键词
儿童/急性淋巴细胞白血病/微小残留病变/复发Key words
Children/Acute lymphoblastic leukemia/Minimal residual disease/Recurrence引用本文复制引用
顿建新,丁玉亭,张艾,王雅琴,刘爱国,胡群..定期监测微小残留病变对儿童急性淋巴细胞白血病的预后价值[J].中国循证儿科杂志,2024,19(3):179-182,4.
