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目的分析儿童双免疫表型白血病的临床及生物学特征,评价儿童急性白血病双免疫表型与治疗相关因素及预后的临床重要性。方法自1998年1月1日至2003年5月31日进入XH99治疗方案的所有新诊治的急性白血病(AL)患儿,诊断采用MICM分型诊断,治疗分别按AMLXH99、ALLXH99危险度分类标准进行分层治疗。用流式细胞仪进行免疫表型分析,根据免疫表型结果将患儿分为4组,伴有/无髄系相关抗原表达的急性淋巴细胞白血病(My+ALL/My-ALL)以及伴有/无淋系相关抗原表达的急性髓系白血病(Ly+AML/Ly-AML)。生存分析采用KaplanMeier方法;生存率之间的比较采用logrank检验;临床及生物学特征与治疗相关因素的分析采用χ2检验或Fisher精确概率法(双尾)。结果①174例提供免疫分型的ALL患儿中,My+ALL患儿34例,占19.54%,其与My-ALL组患儿除在BALL组患儿达缓解时间有统计学差异外(P<0.05),其它临床、生物学特征及治疗反应均无统计学差异(P>0.05);两组患儿5年无事件生存(EFS)率分别为[(61.76±8.33)%与(68.03±5.55)%],logrank检验两组患儿5年EFS率无统计学差异(P=0.0526)。②74例提供免疫分型结果的AML患儿中,Ly+AML患儿18例,占24.32%,其与Ly-AML组患儿临床、生物学特征及治疗反应无统计学差异(P>0.05);两组患儿5年EFS率分别为[(39.82±13.59)%与(51.29±9.70)%],logrank检验两组患儿5年EFS率无统计学差异(P=0.3164)。结论双免疫表型对儿童白血病预后无明显影响,可用同样现行的化疗方案治疗这部分患儿。
Objective To analyze the clinical and biological characteristics of childhood dual immunophenotype leukemia and to evaluate the clinical significance of double immunophenotype and treatment related factors and prognosis in childhood acute leukemia. Methods From January 1, 1998 to May 31, 2003, all newly diagnosed acute leukemia (AL) patients who entered the XH99 treatment regimen were diagnosed by MICM classification and were treated according to AMLXH99 and ALLXH99 risk classification criteria Layered treatment. Immunophenotype analysis was performed by flow cytometry. According to the immunophenotype results, the children were divided into 4 groups, with acute lymphoblastic leukemia (My + ALL / My-ALL) associated with / / Lymphoma-associated antigen-expressing acute myeloid leukemia (Ly + AML / Ly-AML). Survival analysis was performed using the Kaplan Meier method; logrank test was used to compare survival rates; χ2 test or Fisher’s exact test (two-tailed) was used to analyze clinical and biological characteristics and treatment-related factors. Results (1) In 174 cases of ALL children with immunophenotyping, 34 cases (19.54%) of My + ALL patients had significant difference in remission time between children with My-ALL and those with BALL (P < 0.05). There was no significant difference in other clinical, biological and therapeutic responses between the two groups (P> 0.05). The 5-year event-free survival rates were 61.76 ± 8.33% and 68.03 ± 5.55 )%], logrank test 5-year EFS rate was no significant difference between the two groups (P = 0.0526). ② There were 18 cases (24.32%) with Ly + AML in 74 children with AML who had immunophenotyping results. There was no significant difference between the two groups (P> 0.05) in clinical features, biological characteristics and treatment response in Ly-AML group The 5-year EFS rates of the two groups were (39.82 ± 13.59)% and (51.29 ± 9.70)%, respectively. There was no significant difference in 5-year EFS between the two groups (P = 0.3164). Conclusions Dual immunophenotype had no significant effect on the prognosis of children with leukemia. The same current chemotherapy regimen could be used to treat this part of children.