142例儿童急性髓系白血病初诊特征及诱导缓解疗效分析Characteristics of 142 children with newly diagnosed acute myeloid leukemia and analysis of their induction outcome
杨健萍;叶铁真;赖冬波;王嘉怡;何映谊;李彦媚;邱天翔;
摘要(Abstract):
目的分析儿童急性髓系白血病(AML)初诊临床及生物学特征,以期为儿童AML的进一步研究提供依据。方法回顾性分析142例2010年1月-2014年12月在广州市妇女儿童医疗中心确诊为AML患儿的初诊临床资料,并分析其与诱导缓解化疗疗效的关系。结果142例患儿男女比例1.45:1;中位年龄2.42(0.08~13.00)岁;临床表现主要为发热(80.30%)、髓外浸润(64.39%)及出血(46.97%);WBC中位计数为26.00(0.60~483.70)×10~9/L,Hb 71(31~124)g/L,PLT 38(1~404)×10~9/L;骨髓细胞形态前三位依次为M5(33.80%)、M2(25.35%)和M4(14.08%);免疫分型髓系抗原表达按比例依次为CD33、CD13和HLA-DR,伴有淋巴系抗原表达者占31.93%;异常核型检出率为53.66%;白血病相关融合基因检出率为33.33%;DAE及MAE方案诱导缓解化疗后总体完全缓解率(CR)为82.69%。结论142例AML患儿初诊临床特征与国内外文献报道存在不同程度的异同,提示深入开展多中心研究的必要性。
关键词(KeyWords): 急性髓系白血病;儿童;临床特征
基金项目(Foundation):
作者(Author): 杨健萍;叶铁真;赖冬波;王嘉怡;何映谊;李彦媚;邱天翔;
Email:
DOI:
参考文献(References):
- 1.顾龙君,吕善根,卢新天.儿童急性髓细胞白血病诊疗建议.中华儿科杂志,2006,44:877-878.
- 2.卞寿庚.急性髓系白血病//张之南,沈悌.血液病诊断及疗效标准.第3版.科学技术出版社,2007:106-107.
- 3.Hossain MJ,Xie L.Sex disparity in childhood and young adult acute myeloid leukemia(AML)survival:Evidence from US population data.Cancer Epidemiol,2015,39:892-900.
- 4.Lhmann DJ,Abrahamsson J,Ha SY,et al.Effect of age and body weight on toxicity and survival in pediatric acute myeloid leukemia:results from NOPHO-AML 2004.Haematologica,2016,101:1359-1367.
- 5.张银娟,于洁,宪莹,等.儿童急性髓系白血病163例临床分析.中国小儿血液与肿瘤杂志,2014,19:73-77.
- 6.Rubnitz JE,Gibson B.Smith FO.Acute myeloid leukemia.Hematol Oncol Clin North Am,2010,24:35-63.
- 7.Abrahamsson J,Forestier E,Heldrup J,et al.Response-guided induction therapy in pediatric acute myeloid leukemia with excellent remission rate.J Clin Oncol,2011,29:310-315.
- 8.朱嘉莳,蒋慧,陆正华,等.儿童急性髓系白血病的疗效及预后相关因素分析.中华小儿血液与肿瘤杂志,2016,21:211-215.
- 9.de Lima MC,da Silva DB,Freund AP,et al.Acute Myeloid Leukemia-analysis of epidemiological profile and survival rate.J Pediatr(Rio J),2016,92:283-289.
- 10.Gibson B E S,Webb D K H,Howman A J,et al.Results of a randomized trial in children with Acute Myeloid Leukaemia:medical research council AML12 trial.Br J Haematol,2011,155:366-376.
- 11.Imamura T,Iwamoto S,Kanai R,et al.Outcome in 146 patients with paediatric acute myeloid leukaemia treated according to the AML99 protocol in the period 2003-06 from the Japan Association of Childhood Leukaemia Study.Br J Haematol,2012,159:204-210.
- 12.Lange BJ,Smith FO,Feusner J,et al Outcomes in CCG-2961,a children's oncology group phase 3 trial for untreated pediatric acute myeloid leukemia a report from the children's oncology group.Blood,2008,111:1044-1053.
- 3.Mehrvar A,Rahiminejad MS,Hedayati Asl AA,et al.Features of Childhood Acute Myeloid Leukemia in Iran:Report from Double Center Study.Acta Med Iran,2015,53:749-752.
- 4.邢超,杨军军,陈慧,等.156例儿童急性白血病免疫分型研究.中国现代医生,2012,36:96-98.
- 5.Zheng J,Wang X,Hu Y U,et al.A correlation study of immunophenotypic,cytogenetic,and clinical features of 180 AML patients in China.Cytometry B Clin Cytom,2008,74:25-29.
- 6.Langebrake C,Brinkmann I,Teigler-Schlegel A,et al.Immunophenotypic differences between diagnosis and relapse in childhood AML:implications for MRD monitoring.Cytometry B Clin Cytom,2005,63;1-9.
- 17.苏庸春,李欣,于洁,等,71例儿童急性髓系白血病多参数流式细胞术免疫表型分析.第三军医大学学报,2006,28:472-474.
- 18.Paredes-Aguilera R,Romero-Guzman L,Lopez-Santiago N,et al.Biology,clinical,and hematologic features of acute megakaryoblastic leukemia in children.Am J Hematol,2003,73:71-80.
- 19.肖志坚,郝玉书.免疫表型分析与急性白血病诊断.中华血液学杂志,1997,18:53-54.
- 20.Manola KN.Cytogenetics of pediatric acute myeloid leukemia.Eur J Haematol,2009,83;391-405.
- 21.汤静燕.儿童急性髓系白血病相关进展.中华临床医师杂志:电子版,2013,7:1862-1865.
- 22.Pui CH,Carroll WL,Meshinchi S,et al.Biology,risk stratification,and therapy of pediatric acute leukemias:an update.J Clin Oncol,2011,29:551-565.
- 23.Kaspers G J L.Pediatric acute myeloid leukemia.Expert Rev Anticancer Ther,2012,12:405-413.
- 24.Ribeiro RC.Advances in treatment of de-novo pediatric acute myeloid leukemia.Curr Opin Oncol,2014,26:656-662.
- 25.von NeuhoffC,Reinhardt D,Sander A,et al.Prognostic impact of specific chromosomal aberrations in a large group of pediatric patients with acute myeloid leukemia treated uniformly according to trial AML-BFM98.J Clin Oncol,2010,28:2682-2689.
- 26.Kobayashi R,Tawa A,Hanada R,et al.Extramedullary infiltration at diagnosis and prognosis in children with acute myelogenous leukemia.Pediatr Blood Cancer,2007,48:393-398.
- 27.Walter R B,Othus M,Burnett A K,et al.Significance of FAB subclassification of“Acute Myeloid Leukemia,NOS”in the 2008WHO classification:analysis of 5848 newly diagnosed patients.Blood,2013:blood-2012-10-462440.
- 28.Visani G,Bernasconi P,Boni M,et al.The prognostic value of cytogenetics is reinforced by the kind of induction/consolidation therapy in influencing the outcome of acute myeloid leukemiaanalysis of 848 patients.Leukemia,2001,15:903-909.
- 29.Grimwade D,Walker H,Oliver F,et al.The importance of diagnostic cytogenetics on outcome in AML:analysis of 1612 patients entered into the MRC AML 10 trial.Blood,1998,92:2322:2333.
- 30.Raimondi SC,Chang MN,Ravindranath Y,et al.Chromosomal abnormalities in 478 children with acute myeloid leukemia:clinical characteristics and treatment outcome in a cooperative pediatric oncology group study-POG 8821.Blood,1999,94:3707-3716.