CCLG-ALL2014方案治疗儿童急性淋巴细胞白血病的生存分析  

Long-term outcome of childhood acute lymphoblastic leukemia treated with Chinese Children’s Leukemia Group in China-Acute Lymphoblastic Leukemia 2014

作　　者：黄婷婷[1] 王菊香[1] 周海霞[1] 李原[1] 陈敏[1] 胡玲珑 王瑶 黄珍[1] HUANG Tingting;WANG Juxiang;ZHOU Haixia;LI Yuan;CHEN Min;HU Linglong;WANG Yao;HUANG Zhen(Department of Hematology-Oncology,the Second Affiliated Hospital&Yuying Children’s Hospital of Wenzhou Medical University,Wenzhou 325027,China)

机构地区：[1]温州医科大学附属第二医院育英儿童医院儿童血液肿瘤科,浙江温州325027

出　　处：《温州医科大学学报》2021年第11期891-895,共5页Journal of Wenzhou Medical University

摘　　要：目的:探讨中国儿童急性淋巴细胞白血病诊疗建议2014(CCLG-ALL2014)治疗儿童急性淋巴细胞白血病的效果。方法:选择2015年1月至2019年12月在温州医科大学附属第二医院育英儿童医院儿童血液肿瘤科按照CCLG-ALL2014方案进行规范化疗的108例急性淋巴细胞白血病(ALL)患儿的临床资料进行回顾性分析。分析流式细胞术检测的微小残留病(MRD)与患儿预后的关系,并运用Kaplan-Meier法进行长期生存分析。结果:108例ALL患儿中女53例、男55例,年龄5.3(1.0~15.2)岁,随访时间3.3(1.0~5.9)年。107例(99%)患儿获完全缓解,3年总生存(OS)率、无事件生存(EFS)率分别为(92.9±2.6)%、(73.4±4.3)%,复发10例,死亡7例。复发患儿生存率明显小于无复发患儿,3年OS率分别为(50.0±15.8)%和(98.4±1.6)%(χ^(2)=44.884,P<0.001)。诱导第15天MRD>5%者生存率明显低于MRD≤5%者,3年OS率分别为(79.9±8.3)%和(98.7±1.3)%(χ^(2)=10.547,P=0.001)。诱导第33天MRD>10%者3年OS率明显降低,为(37.5±28.6)%。结论:CCLG-ALL2014方案治疗儿童ALL的效果尚可,MRD指导下进行精准的危险分层和个性化治疗来减少复发有望进一步提高儿童ALL的长期生存率。Objective:To analyze the long-term efficacy in childhood acute lymphoblastic leukemia cases enrolled in Chinese Children’s Leukemia Group in China-Acute Lymphablastic Leukemia(CCLG-ALL)2014.Methods:Clinical data of 108 patients diagnosed as ALL and treated with CCLG-ALL2014 protocol between January 2015 and December 2019 in the Department of Hematology-Oncology,the Second Affiliated Hospital&Yuying Children’s Hospital of Wenzhou Medical University were retrospectively analyzed.The relationship between minimal residual disease(MRD)monitored by flow cytometry and prognosis was analyzed,and Kaplan-Meier method was applied for long-term survival analysis.Results:A total of 108 patients with newly diagnosed ALL included 55 males and 53 females with a mean aged of 5.3 years(ranging from 1.0 to 15.2)years and a follow-up period of 3.3 years(ranging from 1.0-5.9).Totally 107 patients(99%)achieved complete remission.The 3-year event free survival(EFS)and overall survival(OS)rates was(73.4±4.3)%and(92.9±2.6)%,respectively.Relapse occurred in 10 cases,and 7 patients died.The 3-year OS rate of patients with relapsed disease was significantly worse than those without(50±15.8)%vs.(98.4±1.6)%,χ^(2)=44.884,(P<0.001).The 3-year OS rate of patients with MRD>5%on day 15 of induction therapy was significantly worse than those with MRD≤5%[(79.9±8.3)%vs.(98.7±1.3)%,χ^(2)=10.547,P=0.001].The 3-year OS rate was obviously lower in patients with MRD>10%on day 33 of induction therapy.Conclusion:CCLG-ALL2014 protocol is effective for childhood ALL.The accurate risk stratification guided by MRD and individualized treatment can reduce the relapse and improve the long-term survival rate of pediatric ALL.

关 键 词：白血病 儿童 生存率 

分 类 号：R725.5[医药卫生—儿科]