Prognostic factors in childhood T-cell acute lymphoblastic leukemia: a Pediatric Oncology Group study.
Prognostic factors in childhood T-cell acute lymphoblastic leukemia: a Pediatric Oncology Group study.
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DOI：
10.1182/blood.v75.1.166.166
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发表时间：
1990
期刊：
影响因子：
20.3
通讯作者：
Jonathan J. Shuster;John;Falletta;Jeanette;William;Crist;G. Humphrey;Barry;Dowell;Moody;Wharam
中科院分区：
文献类型：
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作者：
Jonathan J. Shuster;John;Falletta;Jeanette;William;Crist;G. Humphrey;Barry;Dowell;Moody;Wharam
253名新诊断为t细胞急性淋巴细胞白血病（ALL）的儿童接受改良LSA2L2治疗，使用单变量和递归分区分析来评估与治疗失败风险相关的临床或生物学特征。4年总无事件生存率（EFS）为43% （SE = 4%）。检查的因素包括白细胞（WBC）水平、年龄、性别、种族（黑人vs黑人）、是否有纵隔肿块、肝肿大、脾肿大、明显的淋巴结病变、血红蛋白水平、血小板计数、母细胞抗原表达，如常见的急性淋巴细胞白血病抗原（CALLA、CD10）、HLA-DR和t细胞相关抗原（CD3、CD4、CD8、CD7、CD5和THY）。单因素分析显示，年龄小于或等于5岁、小于或等于7岁、WBC水平小于10、小于25、小于50或小于100 × 10(3)/microL、母细胞CD4、CD8或CALLA表达与较好的EFS相关，而肝肿大和脾肿大与较差的EFS相关。递归划分分析显示，最重要的单一有利预后因素是白细胞计数低于50 × 10(3)/微升，对于白细胞计数低于此水平的患者，最重要的预测因素是胚细胞中单克隆抗体（MoAb）定义的泛t抗原L17F12 （CD5）的表达。对于白细胞水平较高的患者，最重要的EFS预测因子是THY抗原的母细胞表达。递归划分分析定义了三组预后差异很大的患者，确定如下：(1)WBC计数小于50 × 10(3)/微l，缺乏大量脾肿大且细胞表达CD5的患者预后最佳（66%,SE = 7%， EFS 4年，n = 84）；(2) (b1) WBC计数小于50 × 10(3)/微升，伴有巨大脾肿大或原细胞缺乏CD5表达的患者，或（b2） WBC计数大于50 × 10(3)/微升，伴有THY抗原表达的患者预后中等（39%,SE = 7%， 4年EFS， n = 94）；(3)白细胞计数大于50 × 10(3)/微升且细胞缺乏THY抗原表达的患者预后最差（4年时EFS = 19%, SE = 8%, n = 63）。对三组患者的EFS进行三向比较，结果显示三组患者之间存在显著差异（P < 0.001）。递归划分能够对241例（95%）患者进行分类。（摘要删节为400字）
Two hundred fifty-three children with newly diagnosed T-cell acute lymphoblastic leukemia (ALL), who were treated uniformly with modified LSA2L2 therapy, were evaluated using univariate and recursive partition analyses to define clinical or biologic features associated with risk of treatment failure. Overall event-free survival (EFS) at 4 years was 43% (SE = 4%). Factors examined included white blood cell (WBC) level, age, gender, race (black v other), presence of a mediastinal mass, hepatomegaly, splenomegaly, marked lymphadenopathy, hemoglobin level, platelet count, blast cell expression of antigens such as the common acute lymphoblastic leukemia antigen (CALLA, CD10), HLA-DR, and T-cell-associated antigens (CD3, CD4, CD8, CD7, CD5, and THY). Univariate analysis showed that age less than or equal to 5 or less than or equal to 7 years, WBC level less than 10, less than 25, less than 50 or less than 100 x 10(3)/microL, and blast cell expression of CD4, CD8, or CALLA were associated with significantly better EFS, while hepatomegaly and splenomegaly were associated with worse EFS. Recursive partitioning analysis showed that the most important single favorable prognostic factor was a WBC level less than 50 x 10(3)/microL and, for patients with WBC counts below this level, the most important predictor of EFS was blast cell expression of the pan-T antigen defined by the monoclonal antibody (MoAb), L17F12 (CD5). For patients with higher WBC levels, the most important predictor of EFS was blast cell expression of THY antigen. The recursive partitioning analysis defined three groups of patients with widely varied prognoses identified as follows: (1) those with a WBC count less than 50 x 10(3)/microL who lacked massive splenomegaly and had blasts expressing CD5 had the best prognosis (66%, SE = 7%, EFS 4 years, n = 84); (2) those with (b1) WBC counts less than 50 x 10(3)/microL with either massive splenomegaly or who had blasts lacking CD5 expression, or (b2) WBC counts greater than 50 x 10(3)/microL with expression of the THY antigen had an intermediate prognosis (39%, SE = 7% EFS at 4 years, n = 94); (3) those with WBC counts greater than 50 x 10(3)/microL and whose blasts lacked expression of THY antigen had the poorest outcome (EFS = 19% at 4 years, SE = 8%, n = 63). A three-way comparison of EFS according to these groupings showed significant differences among the three patient groups (P less than .001). The recursive partitioning was able to classify 241 (95%) of the patients.(ABSTRACT TRUNCATED AT 400 WORDS)