摘要
目的 :探索影响儿童急性淋巴细胞白血病 (AL L)长期生存的预后因素。方法 :采用回顾性队列研究 ,对 1990年 1月 1日 - 1995年 12月 30日期间在苏州大学附属儿童医院血液科就诊 ,治疗时间大于 2周 ,年龄 <15周岁获得有效随访的 16 4例 AL L 初诊患儿进行生存分析。结果 :16 4例AL L 儿童中位生存时间为 19.5月 ,缓解率为 80 .5 % ,5年生存率 (5 - EFS)为 (19.0± 3.4 ) % ,其中标危和高危急淋的 5 - EFS分别为 (2 3.8± 4 .7) %、(11.3± 4 .4 ) % ,两组差异有显著性 (P<0 .0 5 )。合并数据 COX多因素生存分析显示发病年龄 (<1岁或 >9岁 )、初诊白细胞 (WBC)数 (>2 5× 10 9/ L)、治疗积分 (<5 )显著增加 AL L 儿童生存风险。标危组和高危组的预后因素有所不同。标危急淋儿童的生存风险随着治疗积分的增加、Plt水平的提高而降低。与 F2 型相比 ,F1 细胞分型为预后不良因素。而高危急淋的预后因素有初诊 WBC数、发病年龄、脾脏肿大、治疗积分。结论 :初诊 WBC数、发病年龄、治疗积分是影响 AL L 患儿尤其是高危急淋患儿长期生存较为独立的预后因素。化疗强度的合理提高、持续科学规范的治疗是提高 AL L
Objective:To explore the prognostic factors of the ALL childhood cases of long outcome.Methods:About 164 follow up cases who aged less than 15 year old and initially diagnosed from January 1,1990 to June 30,1995 in the Childhood Hospital Affiliated to Suzhou University were carried out the survival study with retrospective cohort method.Results:Out of the 164 cases, the median survival time was 19.5 months, the remission rate of childhood ALL was 80.5 %. For the 5 EFS, there was significant difference ( P <0.05)between the standard risk group (23.8±4.7) % and the high risk group (11.3±4.4) %.The multivariate COX analysis of the whole subjects showed that the prognostic factors which increased the survival hazard risk of the childhood ALL were the age (<1 or >9), white blood cell (WBC) counts at diagnosis (>25×10 9/L), and therapeutic scores (<5) . The spectrum of the prognostic factors in the standard risk group was different from the high risk group′s. Higher therapeutic scores, elevation of Plt counts ,and the FAB morphology classification (F 2) decreased the hazard risk of standard risk group. However, WBC counts at diagnosis, age, therapeutic scores and the enlargement spleen were the prognostic factors in high risk group.Conclusion:WBC at diagnosis?age and the therapeutic scores are the independent prognostic factors for childhood ALL, especially for the high risk group. Both the intensive ,affordable chemotherapeutic dose and the continuity therapy regimen are attributed to the ALL children′s long outcome.
出处
《白血病．淋巴瘤》
CAS
2002年第5期271-274,共4页
Journal of Leukemia & Lymphoma
