儿童急性淋巴细胞白血病治疗失败的相关因素分析  

The Factors Related to Treatment Failure in Children with Acute Lymphoblastic Leukemia

作　　者：高伟 蒋梦影 高莉 卢俊[1] 肖佩芳[1] 何海龙[1] 王易[1] 潘健[1] 凌婧[1] 孙伊娜[1] 胡绍燕[1] GAO Wei;JIANG Meng-Ying;GAO Li;LU Jun;XIAO Pei-Fang;HE Hai-Long;WANG Yi;PAN Jian;LING Jing;SUN Yi-Na;HU Shao-Yan(Department of Hematology,Children's Hospital of Soochool University,Suzhou 215000,Jiangsu Province,China)

机构地区：[1]苏州大学附属儿童医院血液科,江苏苏州215000

出　　处：《中国实验血液学杂志》2021年第3期661-668,共8页Journal of Experimental Hematology

基　　金：江苏省项目资助(BE2017659,BE2017658,BK20180053,CXTDA2017014);苏州市资助(SS201809和kjxw2018017)。

摘　　要：目的:分析儿童急性淋巴细胞白血病(ALL)接受CCLG-ALL-2008方案治疗的临床疗效和治疗失败的相关因素。方法:回顾性分析2008年3月1日至2012年12月31日在苏州大学附属儿童医院新诊断为ALL并接受CCLG-ALL-2008方案治疗的400例患儿的临床资料,并随访到2019年10月,记录患儿复发和死亡时间及死亡原因。治疗失败定义为复发、非复发性死亡和二次肿瘤。结果:随访10年,共有152例患儿出现复发或者非复发性死亡,治疗失败率为38%,其中复发122例(80.3%),非复发性死亡30例(19.7%)。非复发性死亡包括治疗相关性死亡7例(占23.3%,感染死亡4例,出血死亡3例),骨髓微小残留病灶(MRD)持续阳性8例(占26.7%),经济原因放弃治疗15例(占50%)。按照时间构成,极早期复发37例(30%),早期复发38例(31%),晚期复发47例(39%)。按照复发部位构成,单纯骨髓复发107例,单纯睾丸复发3例,单纯中枢神经系统复发3例,骨髓+睾丸复发5例,骨髓+中枢神经系统复发4例。死亡的89例患儿以骨髓复发为主,其次是神经系统。初诊白细胞数≥50×109/L、免疫表型为T细胞和第12周MRD+为影响患儿复发的独立预后因素。年龄≥10岁、初诊白细胞数≥50×109/L、化疗d 15骨髓状态为M3和第12周骨髓MRD+为治疗失败的独立危险因素。随访10年无一例发生二次肿瘤。结论:复发是治疗失败的最主要原因,初诊白细胞数、免疫表型和第12周骨髓MRD是复发的独立预后因素。因经济因素导致治疗失败是无复发治疗失败的主要原因。Objective:To analyze the efficacy of CCLG-ALL-2008 protocol and the related factors of treatment failure in children with acute lymphoblastic leukemia(ALL).Methods:The clinical data of 400 children newly-diagnosed ALL in Children’s Hospital of Soochow University from March 1,2008 to December 31,2012 was retrospectively analyzed.All the children accepted CCLG-ALL-2008 protocol,and were followed-up until October 2019.The dates of relapse,death and causes of death were recorded.Treatment failure was defined as relapse,non-relapse death,and secondary tumor.Results:Following-up for 10 years,there were 152 cases relapse or non-relapse death,the treatment failure rate was 38%,including 122 relapse(80.3%),30 non-relapse deaths(19.7%) which included 7 cases(4 cases died of infection and 3 cases died of bleeding) died of treatment(23.3% of non-relapse deaths),8 cases died of minimal residual disease(MRD) continuous positive(26.7% of non-relapse deaths) and 15 cases died of financial burden(50% of non-relapse deaths).According to the relapse stage,37 cases(30%) in very early stage,38 cases(31%) in early stage,and 47 cases(39%) in late stage,while according to the relapse site,107 cases relapsed in bone marrow,3 cases in testis,3 cases in central nervous system(CNS),5 cases in bone marrow plus testis and 4 cases in bone marrow plus CNS.Bone marrow relapse was the main cause of death in 89 cases,followed by nervous system.Initially diagnosed WBC count(≥50×109/L),T-cell immunophenotype,and MRD-positive at week 12 were the independent risk prognostic factors for relapse in children with ALL,while age(≥10 years),initially diagnosed WBC count(≥50×109/L),M3 bone marrow on day 15,and MRD-positive at week 12 were the independent risk factors due to treatment failure.No secondary tumors were found during the follow-up for 10 years.Conclusion:Relapse is the main cause of treatment failure in children with ALL.The initially diagnosed WBC count,immunophenotype and MRD at week 12 were the independent prognostic factors for rela

关 键 词：儿童 急性淋巴细胞白血病 CCLG-ALL-2008方案 治疗失败 复发 死亡 

分 类 号：R7.33.71[医药卫生—临床医学]