| Objective:To analyze the clinical data of children with B-lineage Acute Lymphoblastic Leukemia(B-ALL)of CD20 positive and CD20 negative,which treated with CCLG-ALL-2008 protocol,and to explore whether CD20 positive expression is a poor prognostic factor for children with B-ALL,so as to provide a basis for clinical individualized and accurate treatment.Methods:The clinical data of CD20 positive and CD20 negative newly diagnosed B-ALL children treated with CCLG-ALL-2008 protocol in our hospital between March 1,2008 and December 31,2014 were retrospectively analyzed,and the differences in clinical features,MICM classification and treatment response between the two groups were compared.Results:there were 542 children with B-ALL,including 319 males and 223 females,with a male to female ratio of 1.43:1.The median age was 53 months,the minimum 12 months,the maximum 180 months,and the median follow-up time was 73 months(1-130 months).There were 438 cases of survival,95 cases of death,9 cases of lost follow-up,103 cases of recurrence and 16 cases of transplantation,with a mortality rate of 17.5%(95/542)and a recurrence rate of 19%(103/542).In the CD20 positive group(experimental group),there were 87 males and 56 females,with a male to female ratio of 1.55:1.The median age was 49 months,with a minimum of 12 months and a maximum of 180 months.In the CD20 negative group(control group),there were 232 males and 167 females,with a male to female ratio of 1.39:1.The median age was 55 months,with a minimum of 12 months and a maximum of 179 months.Statistical analysis showed that there was no significant difference in gender composition between the two groups(P=0.621).Single factor analysis of two groups of age,white blood cell count,hemoglobin,lactate dehydrogenase,risk,CD10 expression rate,CD 19 expression rate,cCD79a expression rate,fusion,D8 hormone sensitive test,D33 bone marrow morphology response rate,one course of complete remission and relapse than differences had no statistical significance(P>0.05),However,there were statistically significant differences in platelet,CD34 expression rate and D33 bone marrow flow MRD between the two groups(P<0.05).Multi-factor analysis,the significant factors are:platelet,D33 bone marrow flow MRD.Kaplan-meier survival analysis was used to compare OS and EFS between the CD20 positive group and the CD20 negative group,the results showed that the 2-year,3-year,5-year and 7-year OS rates in the two groups respectively were(83.2±3.1)%,(82.5±3.2)%,(77.3±3.5)%,(75.3±4.0)%and(92.5±1.3)%,(89.2±1.6)%,(85.9±1.8)%,(83.7±1.9)%;The 2-year,3-year,5-year and 7-year EFS rates in the two groups respectively were(79.7±3.4)%,(74.8±3.6)%,(69.1±3.9)%,(69.1±3.9)%,and(88.7±1.6)%,(83.7±1.8)%,(78.3±2.1)%,(77.6±2.1)%;The 7-year difference in OS and EFS rates between the two groups was statistically significant(P=0.026,P=0.022).The OS and EFS related univariate and multivariate COX regression analysis were performed on 542 children with B-ALL,the single factor related to the OS is:the CD20,CD 10 expression rate,age,white blood cell count,platelet count,both the risk and risk of eventually,D8 hormone sensitive test,D33 bone marrow morphology,D33 bone marrow streaming MRD,one course of complete remission,relapse;Multivariate analysis found that age,platelet count,and recurrence were independent factors affecting OS.The single factors associated with EFS were:CD20,age,white blood cell count,initial diagnosis risk,final risk,D8 hormone sensitivity test,D33 bone marrow morphology,D33 bone marrow flow MRD,complete response in the first course of treatment;Multi-factor analysis found that CD20,white blood cell count,D8 hormone sensitivity test and D33 bone marrow flow MRD were the independent prognostic factors affecting EFS.Conclusion:1.CD20~+is an independent prognostic factor affecting EFS of children with B-ALL and can be used as an indicator of poor prognosis.2.CD20~+affects OS in children with B-ALL,but is not an independent prognostic factor.3.Children with CD20~+were characterized by low platelet count at initial diagnosis and high negative rate of D33 bone marrow flow MRD.4.Platelet<100 X 109/L at the initial diagnosis is an independent prognostic factor affecting OS in children with B-ALL. |
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