临床儿科杂志 ›› 2016, Vol. 34 ›› Issue (5): 326-.doi: 10.3969 j.issn.1000-3606.2016.05.002

• 血液肿瘤疾病专栏 • 上一篇    下一篇

CCLG-2008 方案治疗儿童急性淋巴细胞性白血病复发因素分析

袁静, 胡绍燕, 柴忆欢, 何海龙, 卢俊, 王易   

  1. 苏州大学附属儿童医院血液肿瘤科(江苏苏州 215000)
  • 收稿日期:2016-05-15 出版日期:2016-05-15 发布日期:2016-05-15
  • 通讯作者: 王易 E-mail:wangdotor@aliyun.com
  • 基金资助:
    江苏省科技厅临床医学科技专项:江苏省临床医学研究中心项目(No.BL2012005);江苏省卫生厅面上项目(No.H201212);江苏省临床重点专病(No.BL2013014);苏州市临床重点专病课题(No.LCZX201507)

Evaluation of clinical features in predicting relapse of childhood acute lymphoblastic leukemia treated with CCLG-2008 protocol

YUAN Jing, HU Shaoyan, CHAI Yihuan, HE Hailong, LU Jun, WANG Yi   

  1. Department of Hematology and Oncology, Suzhou Children’s Hospital Affiliated to Soochow University, Suzhou 215000, Jiangsu, China
  • Received:2016-05-15 Online:2016-05-15 Published:2016-05-15

摘要: 目的 分析CCLG-2008方案治疗儿童急性淋巴细胞白血病(ALL)复发危险因素。方法 回顾性分析2008年12 月1 日至2012 年12 月31 日初诊ALL且使用CCLG-2008 方案化疗的358 例患儿随访至2015 年9 月1 日的复发情况及相关影响因素。结果 随访期间共有79 例患儿复发,复发率22.1%,高危组、中危组、标危组的复发率分别为41.3%、17.6%、13.3%,极早期、早期和晚期复发率分别为31.6%、36.7% 和31.6%。Cox 回归统计显示,初诊白细胞计数>100×109/L、第15 天骨髓M3(骨髓涂片中原始+ 幼稚细胞比例≥25%)、第12 周微小残留病灶(MRD)>10-4 的患儿复发率高,其相对危险度及95%置信区间分别为3.17(1.58 ~ 6.36)、1.87(1.07 ~ 3.30)、1.90(1.12 ~ 3.20),差异有统计学意义(P < 0.05)。结论 高危组CCLG-2008 方案患儿复发率高;初诊白细胞计数、第15 天骨髓呈现M3、第12 周MRD > 10-4是影响复发的重要因素。

Abstract: Objective To evaluate the prognostic factors in predicting relapse of childhood acute lymphoblastic leukemia (ALL) treated with CCLG-2008 protocol. Methods From December 1st 2008 and December 31st 2012, 358 patients diagnosed with ALL and treated with the CCLG- ALL 2008 protocol were enrolled in this study. All patients were followed up until September 1st, 2015. Prognostic impact of clinical features, response to treatment, biological features were analyzed and multivariate analysis of predicted value was performed by Cox- regression analysis. Results After treatment of CCLGALL 2008 protocol, 79 patients suffered from relapse. The relapse rate in the standard-risk, intermediate-risk and the high-risk groups were 13.3%, 17.6%, and 41.3% , respectively (P < 0.05). The number of very early relapse, early relapse and late relapse were 25, 29, 25, respectively, accounting for 31.6 %, 36.7 %, and 31.6 %. The relapse rates in patients in B-ALL with initial leukocyte counts >100×109/L, non-remission in 15th day of induction (M3), the level of minimal residual disease (MRD) on 12w (12w-MRD) >10-4 were significantly higher, their corresponding hazard ratio were 3.17 (1.58 ~ 6.36), 1.87 (1.07 ~ 3.30), and 1.90 (1.12 ~ 3.20), respectively (P < 0.05). Conclusions After treatment with the CCLG-ALL 2008 protocol, a relatively high relapse rate is observed in children with high-risk ALL. High initial leukocyte counts, non-remission in D15-BM and 12w-MRD >10-4 were the independent prognostic factors for childhood B-ALL.