GD-ALL-2008方案治疗后ALL患儿复发的特征及危险因素分析  

Analysis on characteristic and risk factors of relapse in childhood acute lymphoblastic leukemia treated with GD-ALL-2008 protocol

作　　者：钟淑玲 梁会营[1] 王嘉怡[1] 郝文革[1] 江华[1] 孙新[1] ZHONG Shuling LIANG Huiying WANG Jiayi HAO Wenge JIANG Hua SUN Xin(Department of hematology and oncology, Guangzhou Women and Children＇ s Medical Center, Guangzhou Medical University, 510623, China.)

机构地区：[1]广州医科大学附属广州市妇女儿童医疗中心血液肿瘤科,广州510623

出　　处：《中国小儿血液与肿瘤杂志》2017年第5期246-252,共7页Journal of China Pediatric Blood and Cancer

摘　　要：目的分析GD-ALL-2008方案治疗儿童急性淋巴细胞白血病(ALL)的复发情况,明确诱导缓解后复发的因素,为临床更准确地评估早期治疗反应和预测复发提供依据。方法收集2008年6月-2015年2月间在我院接受GD-ALL-2008方案化疗的ALL患儿的临床资料,结合电话随访评估患儿复发情况。通过X^2检验或t检验分析比较计数资料或计量资料的组间情况,用Kaplan-Meier法对复发率进行分析,应用Cox比例风险模型对影响患儿复发的危险因素进行单因素和多因素分析。结果本研究共纳入364名患儿,复发率为19.5%(71/364),中位复发时间14.2(2.7~52.2)个月;5年生存率(OS)为(75.0±3.0)%,5年无事件生存率(EFS)为(71.0±3.0)%。Cox回归多因素分析显示,患儿年龄(RR=1.099,95%CI:1.022~1.182)、初诊白细胞数(RR=1.003,95%CI:1.001~1.005)及BCR/ABL基因阳性(RR=0.013,95%CI:1.313~9.753)是影响复发的独立危险因素。结论年龄≥6岁、初诊白细胞数≥100×10~9/L及BCR/ABL基因阳性是ALL患儿复发的独立危险因素,有利于识别ALL复发的高危患儿,利于临床进行早期干预。Objective To analyze the recurrence rate and the prognostic factors for relapse of childhood acute lymphoblastic leukemia（ALL） treated with GD-ALL-2008 protocol. Methods From June2008 to February 2015, the pediatric patients diagnosed with ALL and treated with the GD-ALL-2008 protocol were enrolled and followed-up was included. Quantitative data were compared by means of t test.Qualitative data were compared by means of the X^2 test. The recurrence rate, compared with that by using the survival analysis Kaplan-Meier method, parallel log-rank inspection. The factor affecting the recurrence of ALL were investigated by multifactorial and monofactorial analyses using Cox proportional hazard model. Results A total of 364 patients were recruited and treated with the GD-2008 ALL protocol. The 5-year recurrence rates was 27±3%. The median time to relapse was 14. 2（2. 7-52. 17）months. The 5-year overall survival（OS） and event free survival（ EFS） were（75±3）%,and（71±3）%,respectively. Furthermore, cox proponional hazard model analysis showed that age（RR=1.099,95% CI ： 1.022-1. 182）; initial leukocyte counts（RR=1.003, 95% CI ： 1.001-1.005）, and appearance of BCR/ABL fusion gene（RR=0.013,95% CI： 1.313-9. 753） were the independent prognostic factors for childhood ALL. Conclusions Age, initial leukocyte counts, and BCR/ABL fusion gene were the independent prognostic factors for relapse in childhood ALL.

关 键 词：急性淋巴细胞白血病 儿童 GD-2008 ALL方案 复发 

分 类 号：R733.71[医药卫生—肿瘤]