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)49.3%,坚持治疗者EFS64.7%,非VHR-ALL组坚持治疗者EFS78.8%。Cox模型分析显示诱导33d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33d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。
[ Objective ] To analyze the treatment outcome 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 49.3%. When the abandoned cases were excluded, the EFS was 64.7%, and for patients with non-VHR-ALL, 78.8%. 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 outcome if they received appropriate treatment. Those with NR on day 33 or BCR-ABL positive should receive stem cell transplantation. The influence of two or more risk factors coexisting on prognosis is to be further evaluated.
出处
《中山大学学报（医学科学版）》
CAS
CSCD
北大核心
2008年第6期767-771,776,共6页
Journal of Sun Yat-Sen University:Medical Sciences
基金
广东省自然科学基金(07001649)
关键词
白血病
淋巴细胞
急性
儿童
高危
治疗失败
预后因素
leukemia, lymphocytic, acute
childhood
high-risk
treatment failure
prognostic factors
