CCLG-ALL 08方案治疗儿童急性淋巴细胞白血病毒副作用的临床研究  

A clinical study of drug-related toxicities of CCLG-ALL 08 protocol for childhood acute lymphoblastic leukemia

作　　者：陈波[1] 宪莹[1] 苏庸春[1] 温贤浩[1] 管贤敏[1] 郑启城[1] 肖莉[1] 邹琳[1] 王世一[1] 李欣[1] 于洁[1] 

机构地区：[1]重庆医科大学附属儿童医院血液肿瘤科,重庆400014

出　　处：《中国当代儿科杂志》2013年第9期737-742,共6页Chinese Journal of Contemporary Pediatrics

摘　　要：目的 2008年中国小儿血液病协作组制定了儿童急性淋巴细胞白血病(ALL)诊疗建议CCLGALL 08方案,本研究旨在评估08方案治疗儿童ALL的相关毒副作用。方法 114例新诊断的ALL患儿采用CCLG-ALL 08方案诊治,分为诱导缓解(VDLD)、早期强化(CAM)、巩固治疗、延迟强化(DIa&DIb)和维持治疗5部分,采用CTCAE v4.0评估药物相关毒副作用。结果毒副作用主要见于VDLD方案,以肝功能损害(87.7%)、口腔溃疡(20.2%)、高血糖(20.2%)、活化部分凝血酶时间延长(21.1%)、纤维蛋白原降低(34.2%)为主,其重度损害的发生率分别为7%、0、1.3%、0.8%、2.7%。L-ASP过敏发生率在延迟强化DIa方案(28.0%)显著高于VDLD方案(7.9%),其中15例换用培门冬酶后未再发生过敏反应。无严重心律失常、心肌缺血及左心功能降低;无骨坏死和肌病发生;无脏器功能衰竭发生;无治疗相关死亡发生。结论 CCLG-ALL 08方案药物相关毒副作用常见于VDLD方案,毒副作用轻微且可逆,无治疗相关死亡发生,提示此方案治疗儿童ALL是安全的。Objective The Chinese Children＇s Leukemia Group （CCLG）-acute lymphoblastic leukemia （ALL） 08 protocol for childhood ALL was established in 2008. This study aims to evaluate the drug-related toxicities of CCLG- ALL 08 protocol in the treatment of childhood ALL. Methods A total of 114 children with newly diagnosed ALL were treated with the CCLG-ALL 08 protocol. The protocol was divided into five phases： remission induction （VDLD）, early reinforcement （CAM）, consolidation therapy, delayed reinforcement （DIa ＆ DIb） and maintenance treatment. Drug-related toxicities in each phase were evaluated according to the Common Terminology Criteria for Adverse Events version 4.0. Results Toxicities were more frequent in phase VDLD than other treatment phases, including hepatotoxicity （87.7%）, dental ulcer （20.2%）, hyperglycemia （20.2%）, prolonged activated partial thromboplastin time （21.1%） and decreased fibrinogen （34.2%）, with the incidence rates of severe adverse events at 7%, 0, 1.3%, 0.8% and 2.7% respectively. The incidence of allergic reaction to L-ASP was significantly higher in phase DIa than in phase VDLD （28.0% vs 7.9%; P 〈0.01）, and there were no longer any allergic reactions in 15 patients who received continuing treatment with pegaspargase instead. There was no severe arrhythmia, myocardial ischemia, decreased left ventricular function, osteonecrosis, myopathy, organ failure or treatment-related mortality. Conclusions The drug-related toxicities of CCLG-ALL 08 protocol are common in phase VDLD, but they are mild and reversible. There is no treatment-related mortality. The CCLG-ALL 08 protocol for childhood ALL is safe.

关 键 词：急性淋巴细胞白血病 CCLG-ALL 08方案 药物相关毒副作用 儿童 

分 类 号：R733.71[医药卫生—肿瘤]