CAJ | 학술논문

目的对中南大学湘雅医院、广西医科大学第一附属医院急性淋巴细胞白血病(ALL)患儿的治疗结果及影响无事件生存率(EFS)的因素进行分析.方法所有病例均采用中华医学会儿科学分会血液学组1998年第二次修正的小儿ALL诊疗建议(简称荣成方案)化疗,采用Kaplan-Meier方法评估依从治疗的188例患儿EFS,组间患儿EFS差异用Log-rank检验,用COX比例风险模型分析独立因素对EFS的影响.结果 374例接受诱导治疗儿童的完全缓解(CR)率为93.6%(354例),全程依从治疗的188例ALL的5年EFS为(68.1±5.6)%,标危、高危组5年EFS分别为(75.2±6.0)%、(47.6±11.6)%;总复发率为10.6%,复发的中位时间为13个月;188例患儿中共有29例死亡,死亡率15.4%;化疗相关死亡13例(7.0%).危险度分组、t(9;22)/bcr-abl融合基因和白细胞计数为独立的不良预后因素.结论两家医院通过荣成方案治疗儿童ALL的总EFS接近70%,需要进行更加详细的危险因素评估和分组,降低治疗相关死亡率,提高儿童ALL治疗的依从性,以进一步提高EFS.
목적 대중남대학상아의원、엄서의과대학제일부속의원급성림파세포백혈병(ALL)환인적치료결과급영향무사건생존솔(EFS)적인소진행분석.방법 소유병례균채용중화의학회인과학분회혈액학조1998년제이차수정적소인ALL진료건의(간칭영성방안)화료,채용Kaplan-Meier방법평고의종치료적188례환인EFS,조간환인EFS차이용Log-rank검험,용COX비례풍험모형분석독립인소대EFS적영향.결과 374례접수유도치료인동적완전완해(CR)솔위93.6%(354례),전정의종치료적188례ALL적5년EFS위(68.1±5.6)%,표위、고위조5년EFS분별위(75.2±6.0)%、(47.6±11.6)%;총복발솔위10.6%,복발적중위시간위13개월;188례환인중공유29례사망,사망솔15.4%;화료상관사망13례(7.0%).위험도분조、t(9;22)/bcr-abl융합기인화백세포계수위독립적불량예후인소.결론 량가의원통과영성방안치료인동ALL적총EFS접근70%,수요진행경가상세적위험인소평고화분조,강저치료상관사망솔,제고인동ALL치료적의종성,이진일보제고EFS.
Objective To analyze the therapeutic effect and the influencing factors of event-free survival(EFS)of childhood acute lymphoblastic leukemia(ALL)in Xiangya Hospital of Central South University and the First Amliated Hospital of Guangxi Medical University.Methods All the patients adopted chemotherapy according to therapeutic guideline revised by the Subspecialty Group of Hematology,The Society of Pediatrics.Chinese Meaical Association for the second-time in 1998(the Rongcheng ALL-98 Protocol).Kaplan-Meier method was used to estimate the survival rates of 188 patients who received therapy with good compliance.The differences of EFS between groups were assessed by Log-rank test.The independent influencing factors on EFS were analyzed by the Cox proportional hazards regression model Results After receiving inductive treatment,354 of 374(93.6%)patients demonstrated a complete remission:188 patients who received complete courses of treatment with good compliance showed(68.1 ±5.6)%five-year EFS.Meanwhile,the five-year EFS in standard-risk(SR)group and hish-risk(HR)group were(75.2±6.0)%and(47.6±11.6)%,respectively.The total relapse rate was 10.6%and the median time to relapse was 13 months.Twenty.nine of 188 patients(15.4%)were dead.and 13 patients (7.0%)died from treatment.related complications.Independent adverse prognostic factors included risk grouping,t(9;22)/bcr-abl gene and leukocyte count.Conclusions The total EFS of childhood ALL patients treated with Rongcheng ALL-98 Protocol in two hospitals was close to 70%.Therefore,it is necessary to evaluate risk factors and consider the grouping in more detail to reduce the treatment-related mortality and to increase the compliance of treatment which can ultimately improve the EFS.