目的评价诱导治疗结束第48小时骨髓不同比例幼稚细胞数及诱导治疗第1疗程结束是否达完全缓解在儿童急性髓系白血病(AML)治疗中的预后价值。方法进入AML-XH-99方案的61例新诊治患儿,诱导治疗第1疗程结束后第48小时及诱导治疗第1疗程结束达完全缓解时行骨髓形态学检查。生存分析采用Kaplan-Meier方法;各组生存率的比较采用Log-rank检验;各生物学特征的比较采用x2检验或Fisher精确概率法(双尾);COX风险比例模型用于评估独立预后因素。结果诱导治疗结束后第48小时骨髓幼稚细胞≥0．15(n=11)与<0．15(n=35)的患儿5年无事件生存(EFS)率差异有统计学意义(18％±15％和49％±11％,P=0．0079);诱导治疗结束后第48小时骨髓不同比例幼稚细胞与患儿诱导治疗第1疗程是否达完全缓解明显相关(P=0．000 028 8)。诱导缓解治疗第1疗程结束达完全缓解时骨髓存在形态学可识别的幼稚细胞(0．00<幼稚细胞< 0．05)的患儿(n=36)5年EFS率为53％±10％,而此时无形态学可辨认的幼稚细胞(幼稚细胞= 0．00)的患儿(n=3)5年均长期存活。诱导缓解治疗第1疗程结束达完全缓解(n=39)与第1疗程结束未完全缓解的患儿(n=22)5年EFS率差异有统计学意义(54％±10％和10％±9％,P=0．0002);多因素分析显示诱导治疗第1疗程结束达完全缓解及起病时有中枢神经系统白血病具有独立的预后价值(风险比例分别为4．007,7．050;95％可信区间分别为1．019-6．613、0．018-0．547,P值分别为0．045,0．008]。结论诱导治疗第1疗程是否完全缓解具有独立的预后价值;诱导治疗结束第48小时骨髓幼稚细胞数可用于预测患儿是否能够诱导治疗1疗程达完全缓解,以便及时采取干预措施提高AML患儿的第1疗程完全缓解率及长期EFS率。 Objective To evaluate the prognostic value of complete remission in the treatment of acute myeloid leukemia (AML) in children at the 48th hour after the end of induction therapy. Methods Sixty-one cases of new diagnosis and treatment of AML-XH-99 were enrolled in this study. Bone marrow morphology was observed at the 48th hour after induction treatment of the first course of treatment and at the end of the first course of induction therapy. Survival analysis was performed using Kaplan-Meier method; Log-rank test was used to compare the survival rates of all groups; x2 test or Fisher’s exact test (two-tailed) was used to compare biological characteristics; and COX risk proportional model was used to evaluate independent prognostic factors. Results The 5-year event-free survival (EFS) rate of children with bone marrow blast cells≥0.15 (n = 11) and <0.15 (n = 35) at the 48th hour after induction therapy was significantly different (18% ± 15% and 49% ± 11%, P = 0.0079). At the 48th hour after induction therapy, different proportion of immature cells in bone marrow significantly correlated with the complete remission of the first course of induction therapy in children (P = 0.000 028 8). The 5-year EFS rate was 53% ± 10% in children with morphologically recognizable naïve cells (0.00