CD20阳性不提示高白细胞计数急性B淋巴细胞白血病患儿预后不良

doi:10.7499/j.issn.1008-8830.2001095

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摘要

目的探讨初诊骨髓白血病细胞CD20表达联合白细胞计数在儿童B系急性淋巴细胞白血病（B-ALL）预后评估中的价值。方法回顾性分析2008年4月至2015年4月接受CCLG-ALL2008方案治疗的821例初诊B-ALL患儿的临床资料，并随访观察其生存情况。结果 821例患儿中，CD20阴性患儿547例（66.6%），CD20阳性患儿274例（33.4%）。694例白细胞 < 50×10⁹/L（低白细胞计数）的患儿中，CD20阳性、CD20阴性患儿5年无事件生存（EFS）率分别为65.9%±3.2%、77.3%±2.0%（P=0.001），5年总生存（OS）率分别为78.3%±2.9%、87.5%±1.6%（P=0.005）；多因素分析示CD阳性是EFS率、OS率的独立危险因素（分别HR=1.634，P=0.001；HR=1.761，P=0.005）。127例白细胞≥50×10⁹/L（高白细胞计数）的患儿中，CD20阳性、CD20阴性患儿5年EFS率分别为64.3%±7.7%、53.7%±5.5%（P=0.135），5年OS率分别为81.4%±6.4%、58.6%±5.6%（P=0.022）；多因素分析示CD20阳性是OS率的独立保护因素（HR=0.367，P=0.016）。结论接受CCLG-ALL2008方案治疗的B-ALL患儿中，初诊低白细胞计数、CD20阳性表达者长期预后较差，而初诊高白细胞计数、CD20阳性表达者有较好的生存趋势。

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	张陆阳
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	邹尧
	竺晓凡

关键词 ：急性淋巴细胞白血病, CD20, 白细胞计数, 预后, 儿童

Abstract：Objective To study the significance of CD20 combined with white blood cell (WBC) count at diagnosis in the prognosis assessment in children with B-lineage acute lymphoblastic leukemia (ALL). Methods A retrospective analysis was performed on the medical data of 821 B-ALL children who were treated with CCLG-ALL2008 regimen from April 2008 to April 2015. Their survival status was followed up. Results Among the 821 children, 547 (66.6%) were negative, while 274 (33.4%) were positive for CD20 expression. Among 694 children with WBC < 50×109/L (lower WBC count), the 5-year EFS rates were 65.9%±3.2% and 77.3%±2.0% for CD20 positive and negative patients respectively (P=0.001); the 5-year OS rates were 78.3%±2.9% and 87.5%±1.6% for CD20 positive and negative patients respectively (P=0.005); CD20 positive expression was an independent risk factor for EFS (HR=1.634, P=0.001) and OS (HR=1.761, P=0.005). Among 127 children with WBC > 50×109/L (higher WBC count), the 5-year EFS rates was 64.3%±7.7% and 53.7%±5.5% for CD20 positive and negative patients respectively (P=0.135); the 5-year OS rate was 81.4%±6.4% and 58.6%±5.6% for CD20 positive and negative patients respectively (P=0.022); CD20 positive expression was an independent protective factor for OS (HR=0.367, P=0.016). Conclusions In children with B-ALL who are treated with CCLG-ALL2008 regimen, those with CD20 positive expression in lower WBC count at diagnosis have a poor prognosis; however, those with CD20 positive expression in higher WBC count at diagnosis have a better long-time survival.

Key words： Acute lymphoblastic leukemia CD20 White blood cell count Prognosis Child

收稿日期: 2020-01-17

基金资助:天津市科技计划（15ZXLCSY00010）。

通讯作者: 竺晓凡,女,主任医师,教授。Email:xfzhu@ihcams.ac.cn。 E-mail: xfzhu@ihcams.ac.cn

作者简介: 张陆阳,女,博士研究生。

引用本文:

张陆阳,陈晓娟,王书春等. CD20阳性不提示高白细胞计数急性B淋巴细胞白血病患儿预后不良[J]. 中国当代儿科杂志, 2020, 22(7): 728-733.

ZHANG Lu-Yang,CHEN Xiao-Juan,WANG Shu-Chun et al. CD20 is not a poor prognostic factor for childhood B-lineage acute lymphoblastic leukemia with high white blood cell count[J]. CJCP, 2020, 22(7): 728-733.

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http://www.zgddek.com/CN/10.7499/j.issn.1008-8830.2001095 或 http://www.zgddek.com/CN/Y2020/V22/I7/728

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