儿童急性淋巴细胞白血病基线数据及早期治疗反应与预后的相关性

doi:10.11958/20231981

天津医药 ›› 2024, Vol. 52 ›› Issue (9): 954-958.doi: 10.11958/20231981

儿童急性淋巴细胞白血病基线数据及早期治疗反应与预后的相关性

杨敏(), 潘艳莎, 张长玲, 陈红英, 郭渠莲, 刘文君^△()

西南医科大学附属医院儿科，四川省出生缺陷临床医学研究中心（邮编646000）

收稿日期:2024-01-03 修回日期:2024-04-19 出版日期:2024-09-15 发布日期:2024-09-06
通讯作者: ^△E-mail：wenjun_liu@swmu.edu.cn
作者简介:杨敏（1989），女，住院医师，主要从事儿童血液系统疾病基础与临床研究。E-mail：869345964@qq.com
基金资助:
四川省科技计划项目(2022YFS0622)

Correlation analysis of baseline data, early treatment response and prognosis in children with acute lymphoblastic leukemia

YANG Min(), PAN Yansha, ZHANG Changling, CHEN Hongying, GUO Qulian, LIU Wenjun^△()

Department of Pediatrics, the Affiliated Hospital of Southwest Medical University, Sichuan Clinical Research Center for Birth Defects, Luzhou 646000, China

Received:2024-01-03 Revised:2024-04-19 Published:2024-09-15 Online:2024-09-06
Contact: ^△E-mail：wenjun_liu@swmu.edu.cn

杨敏, 潘艳莎, 张长玲, 陈红英, 郭渠莲, 刘文君. 儿童急性淋巴细胞白血病基线数据及早期治疗反应与预后的相关性[J]. 天津医药, 2024, 52(9): 954-958.

YANG Min, PAN Yansha, ZHANG Changling, CHEN Hongying, GUO Qulian, LIU Wenjun. Correlation analysis of baseline data, early treatment response and prognosis in children with acute lymphoblastic leukemia[J]. Tianjin Medical Journal, 2024, 52(9): 954-958.

摘要/Abstract

摘要：

目的探讨急性淋巴细胞白血病（ALL）患儿的基线数据及早期治疗反应与预后的相关性。方法 92例ALL患儿依据是否出现终点事件（复发或死亡）分为终点事件组（19例）和无事件生存组（73例），统计初诊年龄、性别，检测初诊白细胞计数（WBC）、初诊血小板计数（PLT）、免疫分型、染色体核型、融合基因、泼尼松试验反应、诱导化疗第15天骨髓缓解状态及诱导化疗第15、33、55天微小残留病变（MRD），分析上述基线数据及早期治疗反应与ALL患儿出现终点事件的相关性。采用Logistic回归分析ALL患儿出现终点事件的影响因素，绘制受试者工作特征（ROC）曲线，并评估基线数据及早期治疗反应对ALL患儿出现终点事件的预测价值。结果终点事件组患儿初诊WBC≥100×10⁹/L、泼尼松反应不良及诱导化疗第33天MRD阳性占比均高于无事件生存组（P<0.05），余指标差异均无统计学意义（P>0.05）。Logistic回归分析显示，泼尼松反应不良、诱导化疗第33天MRD阳性是ALL患儿出现终点事件的危险因素（P<0.05），二者联合预测ALL患儿出现终点事件的价值优于单一指标。结论 ALL患儿泼尼松反应不良、诱导化疗第33天MRD阳性与ALL复发及治疗相关性死亡相关。

关键词: 前体细胞淋巴母细胞白血病淋巴瘤, 肿瘤, 残余, 预后, 儿童, 早期治疗反应

Abstract:

Objective To investigate the correlation between baseline data, early treatment response and prognosis in children with acute lymphoblastic leukemia (ALL). Methods Ninety-two children with ALL were divided into the endpoint event group (19 cases) and the event-free survival group (73 cases) according to whether there was an endpoint event (recurrence or death). The age and gender at initial diagnosis were recorded. Initial white blood cell count (WBC), platelet count (PLT), immunophenotype, chromosome karyotype, fusion gene, prednisone test, bone marrow remission status on the 15^th day of induction chemotherapy and minimal residual disease (MRD) on the 15^th, 33^rd and 55^th day of induction chemotherapy were detected. The correlation between the above baseline data and early treatment response and the occurrence of endpoint event in children with ALL was analyzed. Logistic regression was used to analyze influencing factors of endpoint events in children with ALL. Receiver operating characteristic (ROC) curve was plotted to evaluate the predictive value of baseline data and early treatment response to endpoint events in children with ALL. Results The proportion of WBC ≥100×10⁹/L at first diagnosis, prednisone poor reaction and positive MRD on the 33^rdday of induction chemotherapy were higher in the endpoint event group than those in the event-free survival group (P < 0.05), and there were no significance differences in remaining indicators (P > 0.05). Logistic regression analysis showed that prednisone poor reaction and positive MRD on the 33^rdday of induction chemotherapy were risk factors for endpoint event in children with ALL (P < 0.05), and the combined value of the two indicators was better than that of a single indicator in predicting endpoint events in children with ALL. Conclusion Prednisone poor reaction and positive MRD on the 33^rdday of induction chemotherapy are associated with recurrence and death in children with ALL.

Key words: precursor cell lymphoblastic leukemia-lymphoma, neoplasm, residual, prognosis, child, early treatment response

中图分类号:

R725.5

图/表 5

参考文献 35

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组别	n	性别（男/女）	年龄（<10 岁/≥10岁）	免疫分型（B/T）	染色体核型（正常/亚二倍体/假二倍体/超二倍体）	融合基因（阴性/良性风险/不良风险）	初诊WBC（<100× 10⁹/L/≥100×10⁹/L）	初诊PLT（<20× 10⁹/L/≥20×10⁹/L）
无事件生存组	73	38/35	57/16	63/10	43/1/11/15	41/8/24	68/5	12/61
终点事件组	19	8/11	14/5	18/1	9/0/5/5	13/0/6	14/5	5/14
χ²		0.597	0.166	1.019	2.243	2.476	5.897^＊	0.976

组别	n	性别（男/女）	年龄（<10 岁/≥10岁）	免疫分型（B/T）	染色体核型（正常/亚二倍体/假二倍体/超二倍体）	融合基因（阴性/良性风险/不良风险）	初诊WBC（<100× 10⁹/L/≥100×10⁹/L）	初诊PLT（<20× 10⁹/L/≥20×10⁹/L）
无事件生存组	73	38/35	57/16	63/10	43/1/11/15	41/8/24	68/5	12/61
终点事件组	19	8/11	14/5	18/1	9/0/5/5	13/0/6	14/5	5/14
χ²		0.597	0.166	1.019	2.243	2.476	5.897^＊	0.976

组别	n	泼尼松试验（良好/不良）	骨髓形态（M1/M2/M3）	诱导化疗MRD（阴性/阳性）
组别	n	泼尼松试验（良好/不良）	骨髓形态（M1/M2/M3）	第15天	第33天	第55天
无事件生存组	73	65/8	64/3/6	50/23	57/16	58/15
终点事件组	19	11/8	14/2/1	11/6	5/9	8/6
χ²		10.180^＊	1.800	0.091	10.297^＊	3.193

组别	n	泼尼松试验（良好/不良）	骨髓形态（M1/M2/M3）	诱导化疗MRD（阴性/阳性）
组别	n	泼尼松试验（良好/不良）	骨髓形态（M1/M2/M3）	第15天	第33天	第55天
无事件生存组	73	65/8	64/3/6	50/23	57/16	58/15
终点事件组	19	11/8	14/2/1	11/6	5/9	8/6
χ²		10.180^＊	1.800	0.091	10.297^＊	3.193

变量	β	SE	Wald χ²	P	OR（95%CI）
初诊WBC	1.573	1.122	1.967	0.161	4.823（0.535~43.474）
泼尼松试验	1.624	0.826	3.861	0.049	5.072（1.004~25.618）
诱导化疗第 33天MRD	1.833	0.780	5.521	0.019	6.256（1.355~28.871）
常数项	-2.944	0.576	26.167	<0.001	0.053

儿童急性淋巴细胞白血病基线数据及早期治疗反应与预后的相关性

Correlation analysis of baseline data, early treatment response and prognosis in children with acute lymphoblastic leukemia

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指标	AUC	95%CI	敏感度	特异度	约登指数
泼尼松试验	0.731	0.566~0.896	0.571	0.890	0.461
诱导化疗第33天MRD	0.712	0.554~0.869	0.643	0.781	0.424
二者联合	0.825	0.703~0.947	0.857	0.753	0.610

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