影响儿童急性淋巴细胞白血病预后的多因素分析

目的探索影响儿童急性淋巴细胞白血病(ALL)长期生存的预后因素。方法采用回顾性队列研究,对1998年1月1日至2003年7月1日我院小儿血液科就诊,治疗时间大于6个月,年龄小于15周岁且能够按时随访的ALL初诊患儿进行生存分析。结果76例患儿总诱导缓解率为94.7%,中位生存时间86个月,5年无事件生存率(5-EFS)为(70±1.23)%。合并数据COX回归多因素生存分析显示:初诊时外周血白细胞数50×109/L,血红蛋白含量(60 g/L,肝肋下≥5 cm,泼尼松诱导不敏感,诱导35天骨髓原始、幼稚淋巴细胞55%,治疗不依从,治疗过程中复发,均显著增加ALL儿童生存风险。结论初诊时外周血白细胞数和血红蛋白水平,肝脏肋下大小,35天骨髓原始、幼稚淋巴细胞比例,泼尼松诱导试验,治疗过程中复发,治疗依从性是影响ALL患儿长期生存的独立预后因素,提高治疗的依从性和个体化治疗对提高ALL儿童生存率有重要作用。

A survival study of childhood acute lymphoblastic leukemia

Objective To explore the prognostic factors of long term survival in childhood acute lymphoblastic leukemia(ALL).Methods 76 cases,who aged less than 15 years old and were initially diagnosed from Jan.1st,1998 to Jul.1st,2003 in pediatric hematology department of our hospital,were enrolled in this survival study with retrospective cohort method.All cases were treated over 6 months and could be followed up on time.Results In the 76 cases with childhood ALL,the remission induction rate was 94.7%,the median survival time was 86 months,and the 5 year event free survival(EFS) was(70±1.23)%.The multivariate COX Regression analysis of all subjects showed that the poor prognostic factors included hyperleucocytosis at initial diagnosis(≥50×109/L),low concentration of haematoglobin(Hb)(<60 g/L),the width of liver under rib(≥5 cm),poor response to prednisone,rate of juvinile lymphocyte in bone marrow(BM) on the 35th day of induction therapy(≥5%),relapse after remission,bad compliance to treatment.Conclusions The peripheral white blood cell(PWBC) count,concentration of Hb and the width of liver under rib at initial diagnosis,response to prednisone,rate of juvinile lymphocyte in BM on the 35th day,relapse during the chemotherapy and compliance to treatment are independent prognostic factors in childhood ALL.In order to improve the ALL children's long-term outcome,it is essential to reinforce patients' compliance and to emphasize individualized treatment.