188例急性淋巴细胞性白血病患儿的疗效及预后分析  

Emcacy and prognosis analysis in 188 children with acute lymphoblastic leukemia of China

作　　者：杨明华[1] 贾文广[2] 曹励之[1] 贺钰磊[1] 廖宁[2] 陈国力[2] 罗建明[2] 许望琼[1] 杨静[1] 

机构地区：[1]中南大学湘雅医院儿科,长沙410008 [2]广西医科大学第一附属医院儿科

出　　处：《中华儿科杂志》2008年第7期498-501,共4页Chinese Journal of Pediatrics

基　　金：国家自然科学基金面上项目（30571982,30772353）;教育部博士点基金项目（20070533042）

摘　　要：目的对中南大学湘雅医院、广西医科大学第一附属医院急性淋巴细胞白血病（ALL）患儿的治疗结果及影响无事件生存率（EFS）的因素进行分析。方法所有病例均采用中华医学会儿科学分会血液学组1998年第二次修正的小儿ALL诊疗建议（简称荣成方案）化疗，采用Kaplan-Meier方法评估依从治疗的188例患儿EFS，组间患儿EFS差异用Log-rank检验，用COX比例风险模型分析独立因素对EFS的影响。结果374例接受诱导治疗儿童的完全缓解（CR）率为93．6％（354例），全程依从治疗的188例ALL的5年EFS为（68．1±5．6）％，标危、高危组5年EFS分别为（75．2±6．0）％、（47．6±11．6）％；总复发率为10．6％，复发的中位时间为13个月；188例患儿中共有29例死亡，死亡率15．4％；化疗相关死亡13例（7．0％）。危险度分组、t（9；22）／bcr-abl融合基因和白细胞计数为独立的不良预后因素。结论两家医院通过荣成方案治疗儿童ALL的总EFS接近70％，需要进行更加详细的危险因素评估和分组，降低治疗相关死亡率，提高儿童ALL治疗的依从性，以进一步提高EFS。Objective To analyze the therapeutic effect and the influencing factors of event-free survival （EFS） of childhood acute lymphoblastic leukemia （ALL） in Xiangya Hospital of Central South University and .the First Affiliated Hospital of Guangxi Medical University. Methods All the patients adopted chemotherapy according to therapeutic guideline revised by the Subspecialty Group of Hematology, The Society of Pediatrics, Chinese Medical Association for the second-time in 1998 （ the Rongcheng ALL-98 Protocol）. Kaplan-Meier method was used to estimate the survival rates of 188 patients who received therapy with good compliance. The differences of EFS between groups were assessed by Log-rank test. The independent influencing factors on EFS were analyzed by the Cox proportional hazards regression model. Results After receiving inductive treatment, 354 of 374 （93.6%） patients demonstrated a complete remission; 188 patients who received complete courses of treatment with good compliance showed （68.1 ± 5. 6）% five-year EFS. Meanwhile, the five-year EFS in standard-risk （SR） group and high-risk （HR） group were （75.2 ±6. 0） % and （47. 6 ±11.6） %, respectively. The total relapse rate was 10. 6% and the median time to relapse was 13 months. Twenty-nine of 188 patients （ 15.4% ） were dead, and 13 patients （7. 0% ） died from treatment-related complications. Independent adverse prognostic factors included risk grouping, t （9; 22）/bcr-abl gene and leukocyte count. Condusions The total EFS of childhood ALL patients treated with Rongcheng ALL-98 Protocol in two hospitals was close to 70%. Therefore, it is necessary to evaluate risk factors and consider the grouping in more detail to reduce the treatment-related mortality and to increase the compliance of treatment which can ultimately improve the EFS.

关 键 词：白血病 淋巴细胞 急性 儿童 治疗结果 无病生存 

分 类 号：R686[医药卫生—骨科学]