儿童急性淋巴细胞白血病初诊特征及其与诱导缓解治疗疗效的关系

Initial Clinical Characteristics of Acute Lymphoblastic Leukemia in Children and Their Relationship with the Efficacy of Induced Remission Therapy

摘要: 目的：分析儿童急性淋巴细胞性白血病(ALL)初诊临床特征及其与诱导缓解化疗后完全缓解率之间的关系，以期为预测以及调整治疗方案提供依据。方法：回顾性分析2015年1月~2020年4月在青岛大学附属医院儿童医学中心确诊的179例ALL患儿的初诊临床资料，并进一步分析其与诱导缓解治疗疗效的关系。结果：179例患儿中，低危组患儿107例，中危组66例，高危组6例，男女比例为1.21:1，平均年龄为4.94岁，中位年龄4.00岁。三组患儿初诊时WBC计数具有显著统计学差异(P < 0.001)，Hb、PLT计数无统计学差异(P > 0.05)；患儿在LDH水平具有统计学差异(P < 0.05)，在血清SF水平无显著差异(P > 0.05)。白血病相关融合基因检出率为31.46%。179患儿全部完成诱导缓解化疗，d19天MRD缓解率为73.18%，d46天MRD缓解率为83.24%。患儿初诊时的年龄、WBC计数、LDH水平与d46天MRD缓解率具有相关性。结论：初诊ALL患儿的初诊临床特征与不同研究中心存在异同，年龄、WBC计数及LDH水平与诱导缓解化疗后MRD缓解率之间具有相关性。

Abstract: Objective: To Analyze the relationship between the clinical characteristics of children with acute lymphoblastic leukemia (ALL) at initial diagnosis and the rate of complete response after induced remission chemotherapy, so as to provide a basis for prognosis prediction and treatment adjustment. Methods: The clinical data of 179 children with ALL diagnosed in Children’s Medical Center, Affiliated Hospital of Qingdao University from January 2015 to April 2020 were retrospectively analyzed, and their relationship with the curative effect of induced remission therapy was further analyzed. Results: Among the 179 cases, 107 were in the medium-low risk group, 66 were in the medium-risk group, and 6 were in the high-risk group. The male to female ratio was 1.21:1, the average age was 4.94 years, and the median age was 4.00 years. There were significant differences in WBC count (P < 0.001), but no significant differences in Hb and PLT count (P > 0.05). There was statistical difference in LDH level (P < 0.05), but no significant difference in serum SF level (P > 0.05). The detection rate of leukemia-related fusion gene was 31.46%. All 179 children completed the induction of remission chemotherapy, and the MRD remission rate was 73.18% at d19 day and 83.24% at d46 day. Age at first diagnosis, WBC count and LDH level were correlated with the remission rate of MRD at d46 day. Conclusion: There are similarities and differences in the clinical features and characteristics of newly diagnosed ALL children with different study centers. Age, WBC count and LDH level are correlated with MRD response rate after induction of remission chemotherapy.