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目的分析多种预后影响因素对儿童非成熟B细胞性白血病长期无病生存的影响,寻找可能的影响治疗和预后的最重要的因素。方法对在该院确诊并接受治疗的非成熟B淋巴细胞性白血病患儿161例,按ALL-XH-99方案化疗。并在治疗前获得患者年龄、性别、外周血白细胞数、免疫分型、P170、融合基因以及泼尼松治疗第8天外周血幼稚细胞绝对数、诱导缓解治疗第19天骨髓象以及诱导缓解治疗结束时骨髓微量残留病(MRD)水平和危险度分级等,并动态观测治疗疗效。结果单因素分析显示:性别、治疗前P170水平等对治疗对无事件生存率无影响(P>0.05);年龄、治疗前外周血白细胞水平、泼尼松治疗反应、诱导缓解第19天骨髓象、融合基因、以及CR时MRD水平等则具有显著相关性(P<0.01);免疫分型、是否具有髓系标记以及临床危险度分组对治疗预后亦具有一定程度的影响(<0.05)。多因素COX回归分析结果显示,在所有进入本研究的各种因素的综合分析中,预后危险因素包括:治疗前外周血WBC≥50×109/L、Cμ阳性、MRD阳性以及融合基因检测阳性等(P<0.05)。而性别、年龄、治疗前P170水平、CD10/CD33/CD13是否表达、危险度分组以及治疗第19天骨髓象等对预后并无显著的影响(P>0.05)。但根据患者治疗第19天骨髓象调整治疗方案具有重要意义。结论在非成熟B系ALL中,治疗前外周血高白细胞数、Cμ阳性、融合基因检测阳性以及诱导缓解结束后MRD≥0.01%具有重要的预后意义。而早期治疗反应(第19天骨髓象)对于指导治疗具有重要意义。
Objective To analyze the long-term disease-free survival of children with immature B-cell leukemia and to find out the most important factors that may influence the treatment and prognosis. Methods 161 cases of immature B lymphocytic leukemia diagnosed and treated in our hospital were treated with ALL-XH-99 chemotherapy. The patient’s age, sex, peripheral blood leukocyte count, immunophenotype, P170, fusion gene and the absolute number of naive cells in peripheral blood on the 8th day of prednisone treatment were obtained before treatment to induce remission treatment of bone marrow on the 19th day and induced remission therapy The end of bone marrow residual disease (MRD) levels and risk grading, and dynamic observation of therapeutic effect. Results Univariate analysis showed that gender, pretreatment level of P170 had no effect on event-free survival (P> 0.05); age, peripheral blood leukocyte level before treatment, prednisone treatment response, induction of bone marrow hyperplasia on the 19th day (P <0.01). Immunophenotyping, whether with myeloid markers and clinical risk group also had a certain degree of influence on prognosis (P <0.01). Multivariate Cox regression analysis showed that in all the comprehensive analysis of the various factors involved in the study, the prognostic risk factors include: pre-treatment peripheral blood WBC ≥ 50 × 109 / L, Cμ positive, positive MRD and fusion gene test positive (P <0.05). The gender, age, pre-treatment P170 level, CD10 / CD33 / CD13 expression, risk group and treatment of bone marrow on the 19th day had no significant effect on prognosis (P> 0.05). However, according to the 19th day of treatment of patients with bone marrow adjustment treatment program is of great significance. Conclusion In non-mature B-line ALL, pre-treatment peripheral blood high white blood cell count, positive Cμ, positive fusion gene test and MRD≥0.01% after induction of remission have important prognostic significance. The early treatment response (19th day bone marrow) is of great importance for guiding the treatment.