文章摘要
黄 婕,江 华,顾龙君,薛惠良,汤静燕,王耀平.胞浆μ重链在儿童急性非成熟B淋巴细胞白血病治疗预后中的意义[J].南京医科大学学报,2008,28(12):1598~1601
胞浆μ重链在儿童急性非成熟B淋巴细胞白血病治疗预后中的意义
Prognostic value of cytoplasmic μ heavy chain in childhood immature B-cell acute lymphob- lastic leukemia
投稿时间:2008-06-12  
DOI:10.7655
中文关键词: 儿童  急性淋巴细胞性白血病  预后  融合基因
英文关键词: children  acute lymphoblastic leukemia  prognosis  fusion gene
基金项目:
作者单位
黄 婕 上海交通大学医学院附属上海儿童医学中心血液肿瘤科,上海 200127 
江 华  
顾龙君  
薛惠良  
汤静燕  
王耀平  
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中文摘要:
      目的:探讨胞浆μ重链(Cμ)检测在急性非成熟B淋巴细胞白血病治疗及预后中的指导意义,为寻找可能的合理的治疗方案提供依据?方法:非成熟B淋巴细胞白血病患儿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?融合基因以及强的松治疗第8天外周血幼稚细胞绝对数?诱导缓解治疗第18天骨髓象以及诱导缓解治疗结束时骨髓MRD(微小残留病)水平和危险度分级等,并动态观测治疗疗效?结果:Kaplan-Meier分析显示,Cμ阳性患者5年EFS为(56.7 ± 0.88)%,而Cμ阴性患者(Pro-B和Common B)则达到(74.1 ± 0.05)%?两者差异显著(P < 0.01);χ2分析显示,两组之间的预后差异与患者的生物学特征如性别?年龄?初诊时外周血白细胞(WBC)计数?P170水平?有无髓系标记(My)?融合基因(是否具有BCR/ABL或MLL/AF4)?强的松窗口实验以及治疗第19天骨髓象等无相关性;COX回归风险分析显示,C?滋阳性?治疗前外周血白细胞数WBC≥50 × 109/L?MRD阳性以及融合基因检测阳性等具有独立预后意义(P < 0.05)?结论:C?滋阳性在儿童非成熟B淋巴细胞性白血病化疗中具有重要的不良预后意义,而且这种不良预后与CD10阴性MLL基因重排之间并无相关性?
英文摘要:
      Objective:To investigate the prognostic value of cytoplasmic μ heavy chain(C?滋) in childhood immature B-cell acute lymphoblastic leukemia, in order to provide evidence for rational treatment protocol. Methods:From Jan 1, 2001 to March 31, 2005, 161 patients with immature B-cell acute lymphoblastic leukemia received ALL-XH-99 protocol treatment in our hospital. Baseline data were obtained for age, sex, peripheral white blood cell (WBC) count, immunophenotype, P170 and fusion gene. Absolute peripheral blood juvenile cell count of the eighth day of prednisone treatment, bone marrow smear of the eighteenth day of induction treatment, bone marrow minimal residual disease(MRD) after induction treatment, and risk classification were also assessed. Results:Kaplan-Meier analysis showed that the five-year event-free survival(EFS) rate of Cμ positive patients was 56.7 ± 0.88%, significantly lower than that of the Cμ negative patients(74.1 ± 0.05%,P < 0.01). χ2 analysis indicated that the prognostic difference was unrelated to biological characters such as sex, age, peripheral WBC count when first diagnosed, P170 level, myeloid marker (My), fusion gene(BCR/ABL or MLL/AF4), prednisone window trial and bone marrow smear of the nineteenth day of treatment. Cox regression risk analysis demonstrated that Cμ positive, WBC≥50×109/L before treatment, MRD positive and fusion gene positive were independent risk factors(P < 0.05). Conclusion:Cμ positive is an important risk factor of poor prognosis for childhood immture B-cell lymphoblastic leukemia, and it was independent of CD10 negative MLL gene rearrangements.
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