文章：

继发性急性淋巴细胞白血病是一种具有预后意义的独立临床实体

Secondary acute lymphoblastic leukemia is a distinct clinical entity with prognostic significance

原文发布日期：2017-09-08

DOI: 10.1038/bcj.2017.81

类型: Original Article

开放获取: 是

英文摘要：

The effect of prior malignancy on the risk of developing, and prognosis of, acute lymphoblastic leukemia (ALL) is unknown. This observational study utilized the California Cancer Registry to estimate the risk of developing ALL after a prior malignancy using standardized incidence ratios (SIRs, 95% confidence intervals). ALL occurring after a malignancy with an SIR>1 (increased-risk (IR) malignancies) was considered secondary ALL (s-ALL). Adjusted hazard ratios (aHRs, 95% confidence intervals) compared the effect of s-ALL with de novo ALL on overall survival. A total of 14 481 patients with ALL were identified (1988–2012) and 382 (3%) had a known prior malignancy. Any prior malignancy predisposed patients to developing ALL: SIR 1.62 (1.45–1.79). Hematologic malignancies (SIR 5.57, 4.38–6.98) and IR-solid tumors (SIR 2.11, 1.73–2.54) increased the risk of developing ALL. s-ALL increased the risk of death compared with de novo ALL (aHR 1.38 (1.16–1.63)) and this effect was more pronounced among younger patients (age<40 years: aHR 4.80 (3.15–7.30); age⩾40 years: aHR 1.40 (1.16–1.69)) (interaction P<0.001). This population-based study demonstrates that s-ALL is a distinct entity that occurs after specific malignancies and carries a poor prognosis compared with de novo ALL, particularly among patients <40 years of age.

摘要翻译： 

既往恶性肿瘤对急性淋巴细胞白血病（ALL）的发病风险及预后的影响尚不明确。本观察性研究利用加州癌症登记数据，通过标准化发病率比（SIR，95%置信区间）评估既往恶性肿瘤后发生ALL的风险。将SIR>1的恶性肿瘤（高风险恶性肿瘤）后发生的ALL视为继发性ALL（s-ALL）。采用校正风险比（aHR，95%置信区间）比较s-ALL与原发ALL对总生存期的影响。研究共纳入14,481例ALL患者（1988-2012年），其中382例（3%）有明确既往恶性肿瘤史。任何既往恶性肿瘤均会增加ALL发病风险：SIR 1.62（1.45-1.79）。血液系统恶性肿瘤（SIR 5.57，4.38-6.98）和高风险实体瘤（SIR 2.11，1.73-2.54）尤其显著提升ALL发病风险。与原发ALL相比，s-ALL显著增加死亡风险（aHR 1.38（1.16-1.63）），这一效应在年轻患者中更为突出（年龄<40岁：aHR 4.80（3.15-7.30）；年龄≥40岁：aHR 1.40（1.16-1.69））（交互作用P<0.001）。本基于人群的研究证实，s-ALL是特定恶性肿瘤后发生的独特疾病实体，与原发ALL相比预后更差，尤其在40岁以下患者中更为显著。

原文链接：

Secondary acute lymphoblastic leukemia is a distinct clinical entity with prognostic significance