MRD监测下88例儿童急性B淋巴细胞白血病长期疗效的分析

摘要

Objective To analyse the treatment outcome of 88 childhood B-Lineage acute lymphoblastic leukemia (B-ALL )patients,and explore how to improve the event-free survival (EFS ) rate in ALL. Methods 88 children diagnosed as ALL from January 2005 to May 2008 were analyzed retrospectively.All entered the Children ALL therapy protocol (The third time revised)clinical trial and minimal residual disease (MRD).Kaplan-Meier method was used to estimate survival rates and differences were compared with the 2-side log-rank test,statistics was done by SPSS.Results Out of the 88 patients,86 (97.7%)attained complete remisson (CR).The overall EFS rate at 5 years was 77.2%.The EFS rates at 5 years in low-risk (LR), median-risk (MR)and high-risk (HR)groups were 86.2%,84.6%,63.1%,respectively (P <0.05 ). Relapses occurred in 9 patients (10.5%)in median time of 23 months.Conclusions The early response to improve CR was an important independent prognostic factor.Children ALL therapy protocol (The third time revised)decreased tbe rate of the relapsed and improved the long-term event-free survival rate with MRD.%目的：对88例儿童急性B淋巴细胞白血病（B-ALL）治疗的长期随访结果进行分析，探讨微小残留病（MRD）监测下儿童B-ALL的无事件生存率（EFS ）。方法回顾性分析2005年1月-2008年5月接受儿童ALL诊疗建议（第三次修订草案）治疗的88例B-ALL患儿，应用流式细胞术（FCM）检测MRD，采用Kaplan-Meier方法评估患儿EFS，各临床危险度分组间患儿EFS 差异用Log-rank检验。结果88例患儿骨髓完全缓解（CR）率为97.7％，2年、3年、4年、5年 EFS 率分别为87.5％、86.4％、81.8％、77.2％，标危、中危、高危5年EFS率分别为86.2％、84.6％、63.1％。5例死亡，9例复发（10.5％），复发中位时间为23（3～59）个月。结论采用儿童ALL诊疗建议（第三次修订草案）治疗CR率较高，在MRD监测下指导治疗，总体上B-ALL患儿的5年EFS提高。