Prognostic relationship of prednisone induced test and acute lymphoblastic leukemia in children： a meta-analysis / 中华实用儿科临床杂志

ABSTRACT

Objective To systematically review the prednisone-induced test results for the prognosis assessment of acute lymphoblastic leukemia(ALL) in children.Methods Based on the established inclusion and exclusion criteria,studies of prednisone-induced test in evaluating the prognosis of childhood ALL were electronically searched from January 1990 to November 2016 from PubMed,Embase,The Cochrane Library,WanFang,VIP and CNKI data-base.Two independent researchers browsed literature,extracted data and evaluated the literature quality,Meta-analysis was performed by using RevMen5.3 software.Results A total of 17 articles were included.Meta analysis showed that after completing prednisone induced test in children,the 5 year-event-free survival (5 y-EFS) and 8 y-EFS of good response to prednisone (PGR) was better than that of poor response(PPR) group to prednisone [mean deviation (MD) =22.03,95 ％ CI18.87-25.18,P ＜ 0.000 01;MD =27.90,95 ％ CI20.94-34.85,P ＜ 0.000 01].The continuous complete remission rate and recurrence rate in 2 groups were compared,and the continuous complete remission of PGR group was high [odds ratio (OR) =4.82,95 ％ CI2.81-8.29,P ＜ 0.000 01] and the recurrence rate was low (OR =0.26,95 ％ CI0.11-0.59,P =0.001),and all the differences were statistically significant.There were statistical significance in T cell immune typing,the initial white blood cell count and at day 19(D19) bone marrow(M1,M2) between 2 groups [relative risk (RR) =0.30,95 ％ CI0.20-0.44,P ＜ 0.000 01;OR =0.11,95 ％ CI0.08-0.16,P ＜0.000 01;OR =8.53,95％ CI2.85-25.52,P =0.000 1;OR =0.12,95％ CI0.03-0.39,P =0.000 5].There was no statistical significance in gender(male) and D19 bone marrow(M3) between 2 groups (OR =0.89,95％ CI0.62-1.28,P=0.53;OR=0.24,95％CI0.04-1.44,P=0.12).Conclusion The prednisone induction test is an important index to evaluate the prognosis of children with ALL,and the treatment of prednisone induced test based on selection can improve the prognosis of children.