泼尼松诱导试验评估儿童急性淋巴细胞白血病预后

Prognostic value of response to prednisone in childhood acute lymphoblastic leukemia

摘要:

目的：探讨泼尼松诱导试验评估儿童急性淋巴细胞白血病(ALL)预后的价值。方法：126例ALL初治患儿按ALLXH99治疗方案行泼尼松诱导试验,口服泼尼松(60mg/m2)7d和氨甲蝶蛉加阿糖胞苷鞘内注射1次后外周血涂片计数幼稚淋巴细胞数。若幼稚淋巴细胞数<1000/μL,为泼尼松反应良好;如幼稚淋巴细胞数≥1000/μL,为泼尼松反应不良。生存分析采用KaplanMeier方法;各组生存的比较采用logrank检验;各生物学特征的比较采用χ2检验或Fisher确切概率法(双尾)。结果：110例患儿表现为泼尼松反应良好,16例患儿表现为泼尼松反应不良;5年无事件生存率(pEFS)分别为73%±5%与48%±13%,差异有统计学意义(P=0.0021)。结论：泼尼松诱导试验简单,易操作,可方便地评估早期治疗反应。

Abstract:

OBJECTIVE: The objective of this study was to assess the prognostic value of response to prednisone in children with acute lymphoblastic leukemia (ALL). METHODS: One hundred and twenty-six children with newly diagnosed ALL were enrolled in the protocol of ALL-XH-90. A prednisone good response (PGR) was defined as a blast count of less than 1 000/μL and a prednisone poor response (PPR) as a blast count of at least 1 000/μL in peripheral smears, after 7 days of oral prednisone (60 mg/m~2) and one intrathecal injection of methotrexate along with cytosine arabinoside. The probability of event-free survival (pEFS) was estimated by Kaplan-Meier analysis and the differences in pEFS between groups were assessed by the log-rank test. Differences in the biologic characteristics between groups were compared by Chi-square analysis or Fisher exact test (two-tail). RESULTS: One hundred and ten patients had PGR and 16 had PPR. The 5-year pEFS was significantly worse for patients with PPR compared with those with PGR (48%±13% vs 73%±5%, P= 0.0021). CONCLUSIONS: Response to prednisone is a simple, practical and prognostic factor in childhood ALL.