儿童急性淋巴细胞性白血病治疗依从失败及治疗失败分析  

Failure of treatment and protocol compliance in patients with acute lymphoblastic leukemia

作　　者：汤静燕[1] 薛惠良[1] 顾龙君[1] 陈静[1] 潘慈[1] 陈静[1] 王耀平[1] 叶辉[1] 董璐[1] 邹佳音 

机构地区：[1]上海第二医科大学附属新华医院上海儿童医学中心血液肿瘤科,200127

出　　处：《中华儿科杂志》2005年第7期490-493,共4页Chinese Journal of Pediatrics

摘　　要：目的分析儿童急性淋巴细胞性白血病(ALL)治疗失败的主要原因,并探讨改善预后的措施。方法分析1998年10月1日至2003年6月30日在我院新诊断的ALL病例治疗依从失败的时段、地域差别和对预后的影响;分析患儿治疗失败的危险组、地域差别和主要失败原因。结果新诊断ALL总数为224例,总依从失败率29.5%(66/224例),早期、中期、晚期依从失败率依次为17.0%(38/224)、9.8%(22/224)和2.7%(6/224)。上海本地患儿中晚期依从失败率为10.5%(6/57),外地患儿为17.1%(22/129)。中位随访40个月,治疗失败共52例,占31.7%,未获缓解(CR)、复发及合并症死亡分别为22.6%(37/164)、9.5%(15/164)。高、中、低危险组和不明分组治疗失败率分别为47.1%(24/51)、34.0%(18/53)、9.4%(5/53)和5/7。外地患儿治疗失败率为28.6%(32/112),中晚期依从失败及治疗总失败率为42.9%(32+22/129)。上海患儿治疗失败率为38.5%(20/52),中晚期依从失败加治疗总失败率为45.6%(20+6/57)。结论依从失败和治疗失败二者同等重要,均不容忽视;治疗失败中合并症死亡比例仍较高;中、高危组比例高,分组方法需改进;对治疗并发症尤其是诱导治疗期合并症应有足够的重视。Objective To analyze the main reason of failure in treatment and compliance to protocol in children with acute lymphoblastic leukemia (ALL) at a single institute which is located at the most developed city of China. Methods All the ALL patients who were diagnosed at the hospital from October 1998 to June 2003 were analyzed. The data were extracted from the department′s tumor registry database. Failure in protocol compliance and treatment was analyzed within different risk groups, patients′ resident area, and time period. The patients who had not received any therapy after ALL diagnosis were accounted as early protocol compliance failure, those who received therapy for less than 15 days were regarded as interim failure in protocol compliance, and those who gave up therapy or were lost in follow-up after 15 days with stable disease or complete remission (CR) were accounted as late compliance failure. Results Totally 224 patients were diagnosed to have ALL, of them 38 patients went home without receiving any therapy, i.e., the rate of early protocol compliance failure was 17.1%. Of the remaining 186 patients, 22 (10.5%) belonged to interim protocol compliance failure, and 6 cases discontinued the therapy after 15 days treatment, who were classified into late compliance failure. Six cases (10.5%) were regarded as protocol compliance failure among 57 Shanghainese, and so were 22 cases (17.1%) out of 129 non-Shanghainese. There was no significant difference between the two groups (χ~2=1.332,P> 0.05). Up to a median 40 months follow-up showed that in 52 patients (31.7%) the treatment failed, of which 37 cases (22.6%) died of incomplete response and relapse, and 15 cases (9.5%) died of therapy complication. Among different risk groups, 24 cases (47.1%) came from high risk group, 18 (34.0%) from midium risk group, and 5 (9.4%) from low risk group. Very significant difference was found among the different risk group (χ~2=21.463,P<0.01). Treatment failure was 28.6%(32/112)in non-Shanghainese and 38 .5%(20/52) in Shang

关 键 词：白血病治疗 依从 失败分析 儿童 急性淋巴细胞性白血病 2003年6月 治疗失败 失败率 1998年 治疗并发症 中晚期 合并症 改善预后 分组治疗 分组方法 ALL 患儿 高危组 治疗期 诊断 差别 地域 上海 外地 比例 

分 类 号：R733.71[医药卫生—肿瘤]