目的 通过分析华南地区儿童急性淋巴细胞白血病治疗协作组2016治疗方案(2016 program of the South China children's acute lymphoblastic leukemia treatment cooperation group,SCCLG-ALL-2016)治疗B细胞起源急性淋巴细胞白血病(B cell acute lymphoblastic leukemia,B-ALL)患儿的临床资料,探讨CD20表达对儿童B-ALL预后的影响,为B-ALL临床个性化和精准化治疗提供科学依据.方法 回顾分析华南地区儿童急性淋巴细胞白血病治疗协作组6个中心2016年10月—2023年5月期间接受SCCLG-ALL-2016治疗的273例初诊B-ALL患儿的临床资料,分析其临床特征、染色体核型、融合基因、临床危险度分层、早期和远期疗效,并通过绘制生存曲线进行生存分析.结果 273例初诊B-ALL患儿CD20阳性表达率26.9%,与CD20阴性组比较在白血病基因融合及突变方面差异有统计学意义(P＜0.05).在初诊年龄、性别、初诊白细胞计数、肝脾情况、染色体核型、诱导第15天和第33天骨髓白血病残留以及复发等方面差异无统计学意义(P＞0.05).CD20阳性组总生存率为(71.9±10.1)%,低于CD20阴性组(86.8±4.0)%,3年无病生存率(event-free survival,EFS)为(81.2±5.6)%,低于CD20阴性组(89.5±2.2)%,但2组间差异均无统计学意义(P＞0.05);CD20合并与不合并IKZF1基因片段缺失的总生存率(overall survival,OS)和3年EFS的差异无统计学意义(P＞0.05).3年EFS、OS相关单因素和多因素Cox回归分析,与3年EFS相关的单因素为脾脏情况、危险度分层;多因素分析显示脾脏情况及危险度分层是影响3年EFS的预后独立因素.与OS相关的单因素为脾脏情况、第15天骨髓情况、危险度分层及复发情况,多因素分析显示复发情况是影响OS的预后独立因素.结论 儿童B-ALL的CD20表达与基因融合及突变表达相关,但CD20不是预后影响因素.
Clinical efficacy analysis of the SCCLG-ALL-2016 protocol for the treatment of pediatric B-ALL with CD20+
Objective To analyze the clinical data of children with B-cell acute lymphoblastic leukemia(B-ALL)treated under the SCCLG-ALL-2016 protocol,to explore the impact of CD20 expression on the prognosis of children with B-ALL,and to provide a scientific basis for future clinical personalized and precision clinical treatment.Methods A retrospective analysis of the clinical data of 273 newly diagnosed B-ALL children treated by the South China Children's Acute Lymphoblastic Leukemia Treatment Cooperation Group from six centers between October 2016 and June 2023 was conducted.Clinical features,chromosomal karyotypes,fusion genes,clinical risk stratification,early and long-term outcomes were analyzed,and survival analysis was performed by plotting survival curve methods.Results Among the 273 newly diagnosed B-ALL pediatric patients,the CD20-positive expression rate was 26.9%.When compared to CD20-negative individuals,there were statistically significant differences in terms of leukemia gene fusion and mutations(P＜0.05).However,no statistically significant differences were observed in initial age,gender,initial white blood cell count,liver-spleen condition,chromosomal karyotype,induction bone marrow leukemia residual on days 15 and 33,and relapse(P＞0.05).The CD20-positive group had a total survival rate(OS)of(71.9±10.1)%,lower than the CD20-negative group which was(86.8±4.0)%.The 3-year event-free survival rate(EFS)was(81.2±5.6)%,lower than the CD20-negative group which was(89.5±2.2)%,but the difference between the two groups was not statistically significant(P＞0.05).Moreover,there were no statistically significant differences in the total survival rate and 3-year EFS between CD20-positive patients with or without IKZF1 segment deletion(P＞0.05).Univariate and multivariate Cox regression analyses related to 3-year EFS and OS indicated that spleen condition and risk stratification were related to 3-year EFS in the univariate analysis;multivariate analysis showed that spleen condition and risk stratification were independent prognostic factors affecting 3-year EFS.Factors related to OS in the univariate analysis were spleen condition,bone marrow on day 15,risk stratification,and relapse,with multivariate analysis indicating that relapse was an independent prognostic factor affecting OS.Conclusions In pediatric B-ALL,CD20 expression is related to the expression of fusion genes,yet it is not a prognostic factor.
B cell acute lymphoblastic leukemiachildrenCD20IKZF1survival analysis
NETL
NSTL
万方数据
