儿童急性淋巴细胞白血病的治疗失败相关因素分析———福建省多中心真实世界数据分析  

The Factors Related to Treatment Failurein Childrenwith Acute Lymphoblasticleukemia———Analysis of Multi-Center Datafrom Real Worldin Fujian Province

作　　者：蔡春霞 郑湧智 温红[2] 翁开枝 庄树铨 吴兴国 乐少华[1] 郑浩[1] CAI Chun-Xia;ZHENG Yong-Zhi;WEN Hong;WENG Kai-Zhi;ZHUANG Shu-Quan;WU Xing-Guo;LE Shao-Hua;ZHENG Hao(Department of Pediatric Hematology,Fujian Medical University Union Hospital,Fujian Institute of Hematology,Fujian Provincial Key Laboratory,Fuzhou 350001,Fujian Province,China;Department of Pediatric,The First Affiliated Hospital of Xiamen University,Xiamen 361000,Fujian Province,China;Department of Pediatric Hematology,Rheumatology and Nephrology,Zhangzhou Affiliated Hospital of Fujian Medical University,Zhangzhou 363000,Fujian Province,China;Affiliated to Fujian Medical University,Quanzhou 362000,Fujian Province,China;Department of Pediatric,Quanzhou First Hospital 5Department of Pediatric,Nanping First Hospital,Nanping 353000,Fujian Province,China)

机构地区：[1]福建省血液病研究所,福建省血液病学重点实验室,福建医科大学附属协和医院小儿血液科,福建福州350001 [2]厦门大学附属第一医院儿科,福建厦门361000 [3]福建医科大学附属漳州市医院儿童血液风湿肾科,福建漳州363000 [4]福建医科大学附属泉州第一医院儿科,福建泉州362000 [5]福建省南平市第一医院儿科,福建南平353000

出　　处：《中国实验血液学杂志》2024年第6期1656-1664,共9页Journal of Experimental Hematology

基　　金：福建省卫生健康中青年科研重大项目(2022ZQNZD012)。

摘　　要：目的:分析真实世界中儿童急性淋巴细胞白血病(ALL)的治疗失败相关因素。方法:回顾性分析2011年4月至2020年12月福建省5家医院收治的1414例初诊ALL患儿的临床资料。治疗失败定义为复发、非复发相关死亡和第二肿瘤。结果:中位随访时间为49.7(0.1-136.9)个月,共有269例(19.0%)治疗失败,其中140例(52.0%)为复发,129例(48.0%)为非复发死亡,0例第二肿瘤。Cox单因素及多因素分析结果显示,初诊白细胞计数≥50×10^(9)/L、T-ALL、BCR-ABL1、KMT2A基因重排、早期治疗反应不佳是导致治疗失败的独立危险因素(均HR>1.000,P<0.05)。140例复发ALL患儿的5年OS率仅为23.8%,其中极早期复发(复发时间在诊断18个月内)预后更差。129例非复发死亡患儿中,包括71例(26.4%)治疗相关死亡,56例(20.8%)因放弃治疗死亡,2例(0.7%)疾病进展死亡;其中治疗相关死亡与化疗强度显著相关,而放弃治疗主要与经济因素相关。结论:福建省儿童ALL的治疗失败率仍较高,复发为治疗失败的最主要原因,而治疗相关死亡、经济因素放弃导致死亡则是无复发死亡的主要原因。Objective:To analyze the related factors of treatment failure in children with acute lymphoblastic leukemia(ALL)in real-world.Methods:The clinical data of 1414 newly diagnosed children with ALL admitted to five hospital in Fujian province from April 2011 to December 2020 were retrospectively analyzed.Treatment failure was defined as relapse,non-relapse death,and secondary tumor.Results:Following-up for median time 49.7(0.1-136.9)months,there were 269 cases(19.0%)treatment failure,including 140 cases(52.0%)relapse,and 129 cases(48.0%)non-relapse death.Cox univariate and multivariate analysis showed that white WBC≥50×10^(9)/L at newly diagnosis,acute T-cell lymphoblastic leukemia(T-ALL),BCR-ABL1,KMT2A-rearrangement and poor early treatment response were independent risk factor for treatment failure(all HR>1.000,P<0.05).The 5-year OS of 140 relapsed ALL patients was only 23.8%,with a significantly worse prognosis for very early relapse(relapse time within 18 months of diagnosis).Among 129 patients died from non-relapse death,71 cases(26.4%)were died from treatment-related complications,56 cases(20.8%)died from treatment abandonment,and 2 cases(0.7%)died from disease progression.Among them,treatment-related death were significantly correlated with chemotherapy intensity,while treatment abandonment were mainly related to economic factors.Conclusion:The treatment failure of children with ALL in our province is still relatively high,with relapse being the main cause of treatment failure,while treatment related death and treatment abandonment caused by economic factors are the main causes of non-relapse related death.

关 键 词：急性淋巴细胞白血病 儿童 治疗失败 复发 

分 类 号：R733.7[医药卫生—肿瘤]