低危组儿童急性淋巴细胞白血病远期随访分析  

Long- term follow- up of childhood low- risk ALL patients treated with SCMC- ALL- 2005 protocol

作　　者：胡文婷 薛惠良[1] 陈静[1] 潘慈[1] 沈树红[1] 周敏[1] 叶启东 江华[1] 罗长缨[1] 汤燕静 王坚敏 顾龙君[1] 汤静燕[1] 

机构地区：[1]上海交通大学医学院附属上海儿童医学中心血液肿瘤科,200127

出　　处：《中华血液学杂志》2013年第10期834-838,共5页Chinese Journal of Hematology

基　　金：上海市科委重点项目（08411953800）

摘　　要：目的评估SCMC-ALL-2005方案治疗低危急性淋巴细胞白血病（ALL）患儿的远期疗效。方法2005年5月1日至2009年4月30日采用SCMC-ALL-2005方案治疗ALL患儿共387例，根据细胞形态学、免疫学、细胞遗传学和分子生物学特点及治疗反应进行临床分组，纳入低危组的患儿共158例。对该组患儿进行临床特点、疗效及生存分析。结果随访至2012年12月31日，158例患儿5年无事件生存（EFS）率和总生存（OS）率分别为（77．76±3．37）％和（89．55±2．83）％。中位随访时间5．33（3．75～7．70）年。治疗相关死亡5例（3．16％），均为重症感染。27例（17．09％）复发，其中单纯骨髓复发13例（8．23％）；单纯睾丸复发5例（占男性患儿5．32％），其中单侧2例，双侧3例；单纯中枢神经系统复发6例（3．80％）；骨髓及中枢神经系统同时复发1例；骨髓及睾丸同时复发1例；另有1例复发于右侧卵巢。诱导缓解后微小残留病由阴性转为阳性与复发相关。2例（1．27％）患儿发生第二肿瘤。完全缓解期无特殊原因放弃治疗共4例（2．53％）。结论SCMC-ALL-2005方案治疗ALL低危患儿疗效较为理想，治疗相关死亡率较低，长期无病生存率较我院之前方案有所提高。Objective To evaluate the long-term efficacy of SCMC- ALL- 2005 protocol in treatment of low-risk childhood acute lymphoblastic leukemia （ALL）. Methods From May l, 2005 to April 30, 2009, 387 patients enrolled into SCMC-ALL-2005 protocol. Based on the characteristics of cell morphology, immunology, cytogenetics and molecular biology and treatment response, 158 patients were fit into the low-risk treatment group. All the cases were registered in pediatric oncology network database （POND）. The clinical characteristics and outcome were analyzed. Results Until December 31, 2012, the 5-year event free survival （EFS） and overall survival （OS） is （77.76±3.37）% and （89.55±2.83）%, respectively. Median follow-up time is 5.33 y （3.75-7.70 y）. Five patients （3.16% ） died of complication, all of them were severe infections. Twenty-seven patients （17.09%） relapsed, including 13 bone marrow relapse （8.23%）, 5 testis relapse （5.32% of boys, 2 of unilateral and 3 bilateral）, 6 central nerve system relapse （CNS, 3.80%）, 1 relapse in both bone marrow and CNS, 1 relapse in both bone marrow and testis, and 1 right ovary and fallopian tube relapse. Relapse is related to positive minimal residual disease. Two cases （ 1.27% ） occurred second tumors, 4 patients （2.53%） gave up treatment in complete remission without special reasons. Conclusions The EFS and life quality of SCMC- ALL- 2005 protocol in the treatment of childhood low-risk ALL is satisfactory. The treatment-related mortality rate is lower, and the long-term EFS is higher than that of XH-99 protocol.

关 键 词：白血病 淋巴细胞 急性 儿童 低危 远期随访 

分 类 号：R733.71[医药卫生—肿瘤]