CCCG-ALL-2015方案治疗儿童急性淋巴细胞白血病复发的危险因素分析  

Risk factors for recurrence of childhood acute lymphoblastic leukemia after treatment with the Chinese Children's Cancer Group ALL-2015 protocol

作　　者：陈霞[1] 雷小英[1] 管贤敏[1] 窦颖[1] 温贤浩[1] 郭玉霞[1] 高惠琴 于洁[1] CHEN Xia;LEI Xiao-Ying;GUAN Xian-Min;DOU Ying;WEN Xian-Hao;GUO Yu-Xia;GAO Hui-Qin;YU Jie(Department of Hematology and Oncology,Children's Hospital of Chongqing Medical University/National Clinical Research Center for Child Health and Disorders/Ministry of Education Key Laboratory of Child Development and Disorders/Chongqing Key Laboratory of Pediatrics,Chongqing 400014,China)

机构地区：[1]重庆医科大学附属儿童医院儿童血液肿瘤科/国家儿童健康与疾病临床医学研究中心/儿童发育疾病教育部重点实验室/儿科学重庆市重点实验室,重庆400014

出　　处：《中国当代儿科杂志》2024年第7期701-707,共7页Chinese Journal of Contemporary Pediatrics

摘　　要：目的分析儿童急性淋巴细胞白血病(acute lymphoblastic leukemia,ALL)经中国儿童肿瘤协作组急性淋巴细胞白血病2015方案(Chinese Children's Cancer Group ALL-2015 protocol,CCCG-ALL-2015)治疗后的累积复发率(cumulative incidence of relapse,CIR),并探讨影响复发的危险因素。方法回顾性分析2015年1月—2019年12月接受CCCG-ALL-2015方案治疗的852例患儿的临床资料,计算CIR并分析影响儿童急性B淋巴细胞白血病(B-ALL)复发的危险因素。结果852例ALL患儿中,146例(17.1%)发生复发,8年CIR为(19.8±1.6)%。B-ALL与急性T淋巴细胞白血病患儿的8年CIR比较差异无统计学意义(P>0.05)。146例复发患儿中,复发时间主要集中于极早期(62例,42.5%)和早期(46例,31.5%),极早期单纯骨髓复发42例(28.8%),早期单纯骨髓复发27例(18.5%)。Cox比例风险回归模型分析显示,融合基因MLLr阳性(HR=4.177,95%CI:2.086~8.364,P<0.001)和第46天微小残留病≥0.01%(HR=2.013,95%CI:1.163~3.483,P=0.012)是B-ALL患儿经CCCG-ALL-2015方案治疗后复发的危险因素。结论儿童ALL经CCCG-ALL-2015方案治疗后仍有较高的复发率,以极早期和早期单纯骨髓复发常见;第46天微小残留病≥0.01%、融合基因MLLr阳性与B-ALL复发密切相关。Objective To investigate the cumulative incidence of recurrence(CIR)in children with acute lymphoblastic leukemia(ALL)after treatment with the Chinese Children's Cancer Group ALL-2015(CCCG-ALL-2015)protocol and the risk factors for recurrence.Methods A retrospective analysis was conducted on the clinical data of 852 children who were treated with the CCCG-ALL-2015 protocol from January 2015 to December 2019.CIR was calculated,and the risk factors for the recurrence of B-lineage acute lymphoblastic leukemia(B-ALL)were analyzed.Results Among the 852 children with ALL,146(17.1%)experienced recurrence,with an 8-year CIR of 19.8%±1.6%.There was no significant difference in 8-year CIR between the B-ALL group and the acute T lymphocyte leukemia group(P>0.05).For the 146 children with recurrence,recurrence was mainly observed in the very early stage(n=62,42.5%)and the early stage(n=46,31.5%),and there were 42 children with bone marrow recurrence alone(28.8%)in the very early stage and 27 children with bone marrow recurrence alone(18.5%)in the early stage.The Cox proportional-hazards regression model analysis showed that positive MLLr fusion gene(HR=4.177,95%CI:2.086-8.364,P<0.001)and minimal residual disease≥0.01%on day 46(HR=2.013,95%CI:1.163-3.483,P=0.012)were independent risk factors for recurrence in children with B-ALL after treatment with the CCCG-ALL-2015 protocol.Conclusions There is still a relatively high recurrence rate in children with ALL after treatment with the CCCG-ALL-2015 protocol,mainly bone marrow recurrence alone in the very early stage and the early stage,and minimal residual disease≥0.01%on day 46 and positive MLLr fusion gene are closely associated with the recurrence of B-ALL.

关 键 词：急性淋巴细胞白血病 中国儿童肿瘤协作组急性淋巴细胞白血病2015方案 复发 危险因素 儿童 

分 类 号：R733.71[医药卫生—肿瘤]