中华医学杂志
中華醫學雜誌
중화의학잡지
National Medical Journal of China
2012年
8期
546-550
,共5页
汤静燕%薛惠良%陈静%潘慈%李本尚%顾龙君%董璐%胡文婷%沈树红%周敏叶%启东%江华%罗长缨
湯靜燕%薛惠良%陳靜%潘慈%李本尚%顧龍君%董璐%鬍文婷%瀋樹紅%週敏葉%啟東%江華%囉長纓
탕정연%설혜량%진정%반자%리본상%고룡군%동로%호문정%침수홍%주민협%계동%강화%라장영
白血病,B细胞,急性%儿童%抗肿瘤联合化疗方案%微量残留病
白血病,B細胞,急性%兒童%抗腫瘤聯閤化療方案%微量殘留病
백혈병,B세포,급성%인동%항종류연합화료방안%미량잔류병
Leukemia,B-cell,acute%Child%Antineoplastic combined chemotherapy protocols%Minimal residual disease
目的 评价SCMC-急性淋巴细胞白血病(ALL) -2005方案(泼尼松龙、柔红霉素、门冬酰胺酶、长春新碱、阿糖胞苷、硫鸟嘌呤、环磷酰胺、甲氨蝶呤、地塞米松)治疗儿童ALL的临床疗效及主要预后相关因素.方法 前瞻性制定诊断治疗方案,根据临床危险因素并结合骨髓微量残留病(MRD)检测,将病例分为临床低危、中危和高危组,分别予以不同强度的化疗方案.2005年5月1日至2009年4月30日上海儿童医学中心共连续收住初发B系ALL 351例,分析其诱导缓解率,评估分组、年龄、融合基因及诱导缓解第35天及以后MRD水平对预后的影响.结果273例随访至2011年6月30日,中位随访时间为49个月(26～ 74个月),获得诱导缓解345例(98.29％).年龄＜1岁12例(3.42％),1～9岁285例(81.20％),10—18岁54例(15.38％)；5年无事件生存率(EFS)分别为34％、72％和63％.根据分组标准,低危组156例(44.44％),中危组177例(50.43％),高危组18例(5.13％)；5年EFS分别为78％、64％和30％.伴有BCR/ABL融合基因18例、MLL/AF4 3例、PBX/E2A 16例、TEL/AML 36例；5年EFS分别为11％、66％、75％和74％.诱导治疗35 d进行MRD检测300例,其中241例≤0.01％(阴性),59例＞0.01％(阳性),5年无复发生存率(RFS)分别为79％和58％.治疗相关死亡共6例,占1.71％.未完成治疗(放弃)18例.复发70例,复发率为19.94％,包括骨髓复发52例、单纯中枢神经系统(CNS)复发8例、骨髓和CNS联合复发1例、复发转化为髓系白血病M４1例(考虑为第2肿瘤)和睾丸复发8例.5年总生存率为84％,EFS为69％.结论 SCMC-ALL-2005方案治疗相关病死率低,诱导35 d及以后MRD水平对预后均有影响.高危组、BCR/ABL阳性者和诱导治疗后MRD不能始终保持阴性者预后差.
目的 評價SCMC-急性淋巴細胞白血病(ALL) -2005方案(潑尼鬆龍、柔紅黴素、門鼕酰胺酶、長春新堿、阿糖胞苷、硫鳥嘌呤、環燐酰胺、甲氨蝶呤、地塞米鬆)治療兒童ALL的臨床療效及主要預後相關因素.方法 前瞻性製定診斷治療方案,根據臨床危險因素併結閤骨髓微量殘留病(MRD)檢測,將病例分為臨床低危、中危和高危組,分彆予以不同彊度的化療方案.2005年5月1日至2009年4月30日上海兒童醫學中心共連續收住初髮B繫ALL 351例,分析其誘導緩解率,評估分組、年齡、融閤基因及誘導緩解第35天及以後MRD水平對預後的影響.結果273例隨訪至2011年6月30日,中位隨訪時間為49箇月(26～ 74箇月),穫得誘導緩解345例(98.29％).年齡＜1歲12例(3.42％),1～9歲285例(81.20％),10—18歲54例(15.38％)；5年無事件生存率(EFS)分彆為34％、72％和63％.根據分組標準,低危組156例(44.44％),中危組177例(50.43％),高危組18例(5.13％)；5年EFS分彆為78％、64％和30％.伴有BCR/ABL融閤基因18例、MLL/AF4 3例、PBX/E2A 16例、TEL/AML 36例；5年EFS分彆為11％、66％、75％和74％.誘導治療35 d進行MRD檢測300例,其中241例≤0.01％(陰性),59例＞0.01％(暘性),5年無複髮生存率(RFS)分彆為79％和58％.治療相關死亡共6例,佔1.71％.未完成治療(放棄)18例.複髮70例,複髮率為19.94％,包括骨髓複髮52例、單純中樞神經繫統(CNS)複髮8例、骨髓和CNS聯閤複髮1例、複髮轉化為髓繫白血病M４1例(攷慮為第2腫瘤)和睪汍複髮8例.5年總生存率為84％,EFS為69％.結論 SCMC-ALL-2005方案治療相關病死率低,誘導35 d及以後MRD水平對預後均有影響.高危組、BCR/ABL暘性者和誘導治療後MRD不能始終保持陰性者預後差.
목적 평개SCMC-급성림파세포백혈병(ALL) -2005방안(발니송룡、유홍매소、문동선알매、장춘신감、아당포감、류조표령、배린선알、갑안접령、지새미송)치료인동ALL적림상료효급주요예후상관인소.방법 전첨성제정진단치료방안,근거림상위험인소병결합골수미량잔류병(MRD)검측,장병례분위림상저위、중위화고위조,분별여이불동강도적화료방안.2005년5월1일지2009년4월30일상해인동의학중심공련속수주초발B계ALL 351례,분석기유도완해솔,평고분조、년령、융합기인급유도완해제35천급이후MRD수평대예후적영향.결과273례수방지2011년6월30일,중위수방시간위49개월(26～ 74개월),획득유도완해345례(98.29％).년령＜1세12례(3.42％),1～9세285례(81.20％),10—18세54례(15.38％)；5년무사건생존솔(EFS)분별위34％、72％화63％.근거분조표준,저위조156례(44.44％),중위조177례(50.43％),고위조18례(5.13％)；5년EFS분별위78％、64％화30％.반유BCR/ABL융합기인18례、MLL/AF4 3례、PBX/E2A 16례、TEL/AML 36례；5년EFS분별위11％、66％、75％화74％.유도치료35 d진행MRD검측300례,기중241례≤0.01％(음성),59례＞0.01％(양성),5년무복발생존솔(RFS)분별위79％화58％.치료상관사망공6례,점1.71％.미완성치료(방기)18례.복발70례,복발솔위19.94％,포괄골수복발52례、단순중추신경계통(CNS)복발8례、골수화CNS연합복발1례、복발전화위수계백혈병M４1례(고필위제2종류)화고환복발8례.5년총생존솔위84％,EFS위69％.결론 SCMC-ALL-2005방안치료상관병사솔저,유도35 d급이후MRD수평대예후균유영향.고위조、BCR/ABL양성자화유도치료후MRD불능시종보지음성자예후차.
Objective To reduce the risk of therapy related complication during the treatment and keeps the long term event free survival,and to evaluate the results and risk factors of SCMC- lymphoblastic leukemia( ALL)-2005 protocol. Methods Designed the new protocol SCMC-ALL-2005 based on the previous protocol XH-99 for ALL.Divided the patients into low,median and high risk groups depends on risk factors including day 33 and 55 minimal residual disease (MRD) level.The higher risk group,the more intensive therapy was given.All the cases were registed on pediatric oncology network database (POND).All the abandonment patients were counted as event.From May 1st 2005 to April 30th 2009,351 children who were newly diagnosed as B lineage ALL were enrolled in this study. The prognoses relating to risk grouping,age,mutation gene and MRD level were analyzed.Results Up to June 30,2011,273 patients were followed up with median time 49 months (range 26 to 74 months). Three hundred and forty-five patients(98.29％ ) achieved complete remission on day 35 induction.12 cases were younger than 1 year old (3.42％),285 cases between 1 and 9 years old (81.20％),54 cases 10 to 18 years old( 15.38％ ).Five year event-free survival (EFS) was 34％,72％ and 63％,respectively.One hundred and fifty-six cases belonged to lowere risk (44.44％ ),177 to middle risk (50.43％ ) and 18 to higher risk ( 5.13％ ).Five year EFS was 78％,64％ and 30％,respectively.In this study,18 patients were detected positive for BCR/ABL,3 for MLL/AF4,16 for PBX/E2A,and 36 for TEL/AML.The 5 year EFS were 11％,66％,75％ and 74％,respectively.A total of 300 cases were tested for MRD levels on day 35.Of them,241 cases were with MRD ≤0.01％ ( negative),and 59 cases ＞ 0.01％ (positive).The 5 year relapse free survival (RFS) was 79％ and 58％,respectively.Total 6 patients died of complication ( 1.71％ ).18 patients were abundant treatment with no disease progress.70 patientsrelapsed ( 19.94％ ),including 52 bone marrow,8 central nerve system(CNS),1 both in bone marrow and CNS,1 second caner( M4 ) and 8 testis.Five year overall survival (OS) and EFS are 84％ and 69％.Conclusions The risk of therapy related death is low with the protocol SCMC-ALL-2005.MRD affects the prognosis.The long term prognosis is poor for high risk group,with BCR/ABL and positive MRD.
