文档介绍：儿童高危和超高危急性淋巴细胞白血病的预后因素分析
作者:罗学群, 柯志勇, 黄礼彬, 官晓清, 张婷婷, 张映川, 林苑, 张晓莉, 朱佳, 刘全梁作者单位:中山大学附属第一医院儿科, 广东广州
【摘要】【目的】探讨影响我国儿童高危急性淋巴细胞白血病(HR-ALL)治疗和预后的因素。【方法】收集1999年5月- 2007年3月在我院儿科初诊符合HR-ALL的患儿76例,其中VHR-ALL组41例。治疗上非VHR-ALL用蓉城98高危或ALLIC BFM2002MR方案化疗,VHR-ALL用中山大学附属第一医院高危方案化疗。【结果】总放弃治疗率25%,总预期6年无事生存率(EFS)%,坚持治疗者EFS %,非VHR-ALL组坚持治疗者EFS %。Cox模型分析显示诱导33 d不缓解或BCR-ABL阳性是不良的独立预后因素,高强度化疗不能改变其预后差的特性,而泼尼松不敏感与其它任一项高危因素并存时复发的危险性明显增高。【结论】放弃治疗和复发是本组治疗失败的前2位原因,多数HR-ALL如能坚持合理治疗应有信心获得较好的预后,诱导33 d不缓解或BCR-ABL阳性患者应争取造血干细胞移植,2项或以上高危因素并存对预后的影响值得深入研究。
【关键词】白血病,淋巴细胞,急性; 儿童; 高危; 治疗失败; 预后因素
Analysis of Prognostic Factors of High-risk and Very High-Risk Childhood Acute Lymphoblastic Leukemia
LUO Xue-qun, KE Zhi-yong, HUANG Li-bin, GUAN Xiao-qing, ZHANG Ting-ting, ZHANG Ying-chuan,
ZHANG Xiao-li, ZHU Jia, LIU Quan-liang
( Department of Pediatric, The First Affiliated Hospital of SUN Yat-sen University, Guangzhou 510080, China )
Abstract: 【Objective】 To analyze the treatment e and prognostic factors of childhood high-risk acute lymphoblastic leukemia (HR-ALL) in China. 【Methods】 During May 1999 to March 2007, 76 children were newly diagnosed with HR-ALL(41 with VHR-ALL). Treatment protocols were China-98 high-risk/ALLIC BFM2002MR and in-house high-risk protocol for non-VHR and VHR patients respectively. 【Results】 The rate of treatment abandonment was 25%. 6-year possibility event-free survival (EFS) of all cases was %. When the abandoned cases were excluded, the EFS was %, and for patients with non-VHR-ALL, %. Either NR on day 33 or BCR-ABL remained as an adverse independent risk factor although more intense chemotherapy was administrated. The risk of relapse was significantly increased when PPR and any another risk factor coexisted. 【Conclusion】 Abandonment and relapse were two major causes of treatment failure in this group. Confidence should be built up since most children with HR-ALL could have a good e if they received appropriate treatment. Those with NR on day