CCLG-ALL2008方案治疗儿童急性淋巴细胞白血病复发患儿的特征分析  

Clinical features of children with relapsed acute lymphoblastic leukemia treated with the CCLG-ALL2008 protocol

作　　者：陈晓娟 邹尧 杨文钰 郭晔 王书春 张丽 刘晓明 阮敏 刘天峰 戚本泉 竺晓凡 

机构地区：[1]中国医学科学院/血液学研究所/血液病医院/儿童血液病诊疗中心,天津300020

出　　处：《中国当代儿科杂志》2015年第4期321-326,共6页Chinese Journal of Contemporary Pediatrics

基　　金：天津市科技支撑计划(12ZCDZSY18100);国家科技支撑计划(2007BA104B03)

摘　　要：目的了解CCLG-ALL2008方案治疗儿童急性淋巴细胞白血病(ALL)复发患儿的临床特征。方法选取2008年4月至2013年6月间初诊为儿童ALL,并接受CCLG-ALL2008方案治疗的591例患儿,回顾性分析并随访观察其中80例复发患儿的临床特征。结果 CCLG-ALL2008方案治疗后标危组、中危组、高危组复发率分别为7.0%、10.7%、28.7%(P<0.05)。TEL/AML1阳性ALL患儿复发率为8.0%,其复发患儿5年预期总生存率(OS)为37.04%;MLL阳性与BCR/ABL阳性ALL患儿复发率分别为35.0%和24.2%,5年OS为0。复发者以超早期为主,占53%,超早期复发者5年OS为0;早期和晚期复发分别占34%和14%,其5年OS分别为11.44%和60.00%。复发部位以单纯骨髓复发为主(83%),单纯骨髓复发患儿5年OS为9.23%;骨髓伴有骨髓外复发患儿占11%,其5年OS为25.00%;单纯骨髓外复发患儿占6%,其5年OS为100%。T细胞型ALL患儿复发率为9.5%,其复发患儿5年OS为0;B细胞型ALL患儿复发率为14.3%,其复发患儿5年OS为15.52%。结论 CCLG-ALL2008方案治疗后高危组患儿复发率较高;MLL、BCR/ABL等基因阳性是高危复发因素。免疫分型与复发率无明显相关性。早期复发、单纯骨髓复发、T细胞型ALL复发及伴有BCR/ABL、MLL等基因异常者复发后生存率极低。Objective To study the clinical features of children with relapsed acute lymphoblastic leukemia（ALL） treated with the CCLG-ALL2008 protocol. Methods The data of 591 children who were newly diagnosed with ALL and were treated with the CCLG-ALL 2008 protocol between April 2008 and June 2013 were collected, and the clinical features of 80 children with relapsed ALL were retrospectively analyzed. Results After treatment with the CCLGALL2008 protocol, the recurrence rate in the standard-risk, intermediate-risk and the high-risk groups were 7.0%, 10.7% and 28.7% respectively（P〈0.05）. The recurrence rate in patients with TEL/AML1-positive ALL was 8.0%, and the 5-year overall survival（OS） of the relapsed patients was 37.04%. The recurrence rates in patients with MLL-positive and BCR/ABL-positive ALL were 35.0% and 24.2% respectively, and none of the relapsed patients had long-term survival. The recurrence mainly occurred at the very early stage（53%）, and none of patients with recurrence at the very early stage had long-term survival. The recurrence occurred at early stage and late stage accounted for 34% and 14% respectively, and the 5-year OS rates of patients with recurrence at early stage and late stage were 11.44% and 60.00% respectively. The sites of recurrence were mainly bone marrow alone（83%）, and the 5-year OS of patients with recurrence at bone marrow alone was 9.23%. The recurrence in bone marrow and outside bone marrow accounted for 11%, and the 5-year OS of patients with recurrence in both bone marrow and outside bone marrow was 25.00%. The recurrence only outside bone marrow accounted for 6%, and the 5-year OS of patients with recurrence only outside bone marrow was 100%. The recurrence rate in patients with T-cell ALL was 9.5%, and none of the relapsed patients had long-term survival. The recurrence rate in patients with B-cell ALL was 14.3%, and the 5-year OS of the relapsed patients was 15.52%. Conclusions After treatment with the CCLG-ALL2008 protocol, a relatively high recurrence

关 键 词：急性淋巴细胞白血病 复发 生存率 儿童 

分 类 号：R733.71[医药卫生—肿瘤]