【摘要】：目的研究10歲以上兒童青少年初診急性淋巴細胞白血病(ALL)患兒的臨床特點及預后。方法對86例10歲以上ALL患兒(B-ALL 62例,T-ALL 24例)的臨床特點、治療療效及預后因素進行回顧性分析,采用Kaplan-Meier分析評估患兒無事件生存率(EFS)和總生存率(OS),COX回歸模型評估EFS、OS的影響因素。結果 86例患兒中,中危組和高危組患兒分別為62例和24例。首診表現(xiàn)為肝腫大的53例(62%),脾腫大50例(58%),淋巴結腫大46例(54%)。初診時外周血WBC≥50×109/L者29例(34%)。78例進行了染色體核型分析,21例(27%)染色體數(shù)目異常,其中15例為超二倍體(19%)、4例(5%)為亞二倍體,2例(3%)為假二倍體;11例(14%)染色體結構異常,其中Ph染色體陽性1例,t(1;19)1例。TEL-AML1融合基因3例(4%),E2A-PBX1融合基因3例(4%),BCR-ABL融合基因6例(7%),SIL-TAL1融合基因4例(5%)。1療程完全緩解率為99%(85/86)。5年EFS率、OS率分別為64%±6%和75%±5%。中危組的5年EFS率、OS率均高于高危組(P0.05)。B-ALL患兒5年EFS率優(yōu)于T-ALL組(P0.05)。COX多因素回歸分析顯示,初診時白細胞計數(shù)、誘導緩解末微小殘留病是EFS、OS的獨立影響因素。結論 10歲以上ALL患兒具有不利預后的臨床特征,初診時白細胞計數(shù)、誘導緩解末MRD是決定遠期療效的重要因素。
[Abstract]:Objective to study the clinical characteristics and prognosis of children over 10 years old with newly diagnosed acute lymphoblastic leukemia (ALL). Methods the clinical features, therapeutic efficacy and prognostic factors of 86 children over 10 years old with ALL (B-ALL 62, T-ALL 24) were retrospectively analyzed. The event-free survival rate (EFS) and total survival rate (OS),) were evaluated by Kaplan-Meier analysis. COX regression model was used to evaluate the influencing factors of EFS,OS. Results among the 86 cases, 62 cases in the middle-risk group and 24 cases in the high-risk group were in the middle-risk group and in the high-risk group. The first diagnosis was hepatomegaly in 53 cases (62%), splenomegaly in 50 cases (58%) and lymphadenopathy in 46 cases (54%). At the time of initial diagnosis, WBC 鈮，

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