儿童急性巨核细胞白血病临床特点及预后分析

Clinical features and prognosis of pediatric acute megakaryocytic leukemia

摘要:

目的 研究儿童急性巨核细胞白血病（acute megakaryocytic leukemia，AMKL）的临床特点及急性髓系白血病（acute myeloid leukemia，AML）03方案的疗效及预后。方法 收集2011年5月至2019年12月确诊为AMKL的47例患儿的临床资料，分析其疗效及预后因素。采用Kaplan-Meier法及log-rank检验进行生存分析。结果 47例AMKL患儿中，22例非唐氏综合征AMKL患儿使用AML03方案治疗，中位随访时间为11.4个月。非唐氏综合征AMKL患儿诱导Ⅱ后骨髓细胞学缓解率为85%，微小残留病（minimal resident disease，MRD）阴性率为79%；2年总生存（overall survival，OS）率及无事件生存（event-free survival，EFS）率分别为50%± 13%和40%±12%。单因素分析提示：免疫表型标志物CD56阳性组2年EFS率、OS率均低于CD56阴性组（P < 0.05）；诱导Ⅱ后骨髓细胞学未缓解组2年EFS率及OS率均低于缓解组（P < 0.05）；诱导Ⅱ后MRD阳性组2年EFS率低于MRD阴性组（P < 0.05）；移植与非移植患儿2年OS率与EFS率比较差异无统计学意义（P > 0.05）。结论 儿童AMKL缓解率低，预后较差。免疫表型标志物CD56阳性、早期治疗反应中的骨髓细胞学及MRD结果是影响预后的重要因素。异基因造血干细胞移植对AMKL预后无显著影响。

Abstract:

Objective To study the clinical features and prognosis of children with acute megakaryocytic leukemia (AMKL) and the clinical effect of acute myeloid leukemia 03 (AML03) regimen for the treatment of pediatric AMKL. Methods The clinical data were collected from 47 children with AMKL who were diagnosed from May 2011 to December 2019. The treatment outcomes and prognostic factors were analyzed. The Kaplan-Meier method and the log-rank test were used for survival analysis. Results Among the 47 children with AMKL, 22 with non-Down syndrome-AMKL were treated by the AML03 regimen, with a median follow-up time of 11.4 months. For the 22 non-Down syndrome-AMKL patients, the remission rate of bone marrow cytology was 85% and the negative rate of minimal residual disease (MRD) was 79% after induction Ⅱ, with a 2-year overall survival (OS) rate of (50±13)% and a 2-year event-free survival (EFS) rate of (40±12)%. The group with positive immunophenotypic marker CD56 had significantly lower 2-year EFS and OS rates than the group with negative CD56 (P < 0.05). The group without remission of bone marrow cytology after induction Ⅱ had significantly lower 2-year EFS and OS rates than the group with remission (P < 0.05). The group with positive MRD after induction Ⅱ had a significantly lower 2-year EFS rate than the group with negative MRD (P < 0.05). There was no significant difference in 2-year OS and EFS rates between the patients with transplantation and those without transplantation (P > 0.05). Conclusions Children with AMKL tend to have a low remission rate and a poor prognosis. Positive immunophenotypic marker CD56, bone marrow cytology during early treatment response, and MRD results are important factors influencing the prognosis. Allogeneic hematopoietic stem cell transplantation has no significant effect on the prognosis of AMKL.