Objective: To evaluate the efficacy of acute T-cell lymphoblastic leukemia (T-ALL) in children and explore the prognostic risk factors.
Methods: The clinical data of 127 newly diagnosed children with T-ALL admitted to five hospitals in Fujian province from April 2011 to December 2020 were retrospectively analyzed, and compared with children with newly diagnosed acute precursor B-cell lymphoblastic leukemia (B-ALL) in the same period. Kaplan-Meier analysis was used to evaluate the overall survival (OS) and event-free survival (EFS), and COX proportional hazard regression model was used to evaluate the prognostic factors. Among 116 children with T-ALL who received standard treatment, 78 cases received the Chinese Childhood Leukemia Collaborative Group (CCLG)-ALL 2008 protocol (CCLG-ALL 2008 group), and 38 cases received the China Childhood Cancer Collaborative Group (CCCG)-ALL 2015 protocol (CCCG-ALL 2015 group). The efficacy and serious adverse event (SAE) incidence of the two groups were compared.
Results: Proportion of male, age≥10 years old, white blood cell count (WBC)≥50×109/L, central nervous system leukemia, minimal residual disease (MRD)≥1% during induction therapy, and MRD≥0.01% at the end of induction in T-ALL children were significantly higher than those in B-ALL children (P <0.05). The expected 10-year EFS and OS of T-ALL were 59.7% and 66.0%, respectively, which were significantly lower than those of B-ALL (P <0.001). COX analysis showed that WBC≥100×109/L at initial diagnosis and failure to achieve complete remission (CR) after induction were independent risk factors for poor prognosis. Compared with CCLG-ALL 2008 group, CCCG-ALL 2015 group had lower incidence of infection-related SAE (15.8% vs 34.6%, P =0.042), but higher EFS and OS (73.9% vs 57.2%, P EFS=0.090; 86.5% vs 62.3%, P OS=0.023).
Conclusions: The prognosis of children with T-ALL is worse than children with B-ALL. WBC≥100×109 /L at initial diagnosis and non-CR after induction (especially mediastinal mass has not disappeared) are the risk factors for poor prognosis. CCCG-ALL 2015 regimen may reduce infection-related SAE and improve efficacy.
题目: 儿童急性T淋巴细胞白血病的临床特征及预后——福建地区多中心数据分析.
目的: 评估儿童急性T淋巴细胞白血病（T-ALL）的疗效，并探讨影响预后的危险因素。.
方法: 回顾性分析2011年4月至2020年12月福建地区5家医院收治的127例初诊T-ALL患儿的临床资料，与同期急性前体B淋巴细胞白血病（B-ALL）患儿相比较，并采用Kaplan-Meier法分析评估患儿总生存率（OS）和无事件生存率（EFS），COX比例风险回归模型分析预后影响因素。116例规范治疗的T-ALL患儿中，78例接受CCLG-ALL 2008方案治疗，38例接受CCCG-ALL 2015方案治疗，对比两组的疗效及严重不良事件发生率。.
结果: T-ALL患儿中男性、年龄≥10岁、初诊白细胞数≥50×109/L、合并中枢神经系统白血病、诱导治疗中微小残留病≥1%、诱导结束时微小残留病≥0.01%的患儿比例均显著高于B-ALL患儿（P <0.05）。T-ALL患儿预期10年EFS及OS分别为59.7%和66.0%，均显著低于B-ALL患儿（P <0.001）。COX分析显示，初诊白细胞数≥100×109/L、诱导结束时未达完全缓解是更差预后的独立危险因素。CCCG-ALL 2015组与CCLG-ALL 2008组相比，感染相关严重不良事件发生率更低（15.8% vs 34.6%，P =0.042），而EFS及OS更高（73.9% vs 57.2%，P EFS=0.090；86.5% vs 62.3%，POS=0.023）。.
结论: T-ALL较B-ALL预后差，初诊白细胞数≥100×109/L、诱导结束时未达完全缓解（尤其是纵隔肿物未消失）为其预后不良危险因素。CCCG-ALL 2015方案可能降低感染相关严重不良事件发生率并提高疗效。.
Keywords: acute T-cell lymphoblastic leukemia; adverse event;; child; efficacy.