中华儿科杂志
中華兒科雜誌
중화인과잡지
Chinese Journal of Pediatrics
2014年
9期
649-654
,共6页
中华医学会儿科学分会血液学组%中国抗癌协会儿科专业委员会
中華醫學會兒科學分會血液學組%中國抗癌協會兒科專業委員會
중화의학회인과학분회혈액학조%중국항암협회인과전업위원회
淋巴瘤,非霍奇金%B淋巴细胞%儿童%多中心研究
淋巴瘤,非霍奇金%B淋巴細胞%兒童%多中心研究
림파류,비곽기금%B림파세포%인동%다중심연구
Lymphoma,non-Hodgkin%B-lymphocytes%Child%Multicenter study
目的 探讨儿童成熟B细胞非霍奇金淋巴瘤(B-NHL)诊治方案(CCCG-B-NHL 2010)的疗效,为进一步改善多中心协作管理模式和方案改进提供依据.方法 8个医疗单位参与此项回顾性研究.收集2009年4月1日至2012年3月31日收治的年龄≤18岁的初治B-NHL和成熟B细胞型急性淋巴细胞白血病(B-ALL)病例,最后随访时间为2014年1月31日.104例患儿均按照CCCG-B-NHL 2010方案进行治疗.其中23例患儿在CCCG-B-NHL 2010基础上联合利妥昔单抗治疗.分析患儿临床特征、治疗结果,并应用Kaplan-Meier法对患儿进行生存分析.结果 104例患儿中男79例,女25例,中位年龄6.1岁(1.8～15.1岁).其中Ⅰ期2例,Ⅱ期22例,Ⅲ期65例,Ⅳ期9例,B-ALL 6例.单纯化疗组(81例)和联合利妥昔单抗组(23例)在疾病分期和乳酸脱氢酶(LDH)水平分布上差异均无统计学意义(x2 =1.44和3.99,P均＞0.05).本组6例患儿病情未缓解并进展至死亡,12例复发,其中11例复发时间6.9个月(3.1 ～23.4个月),另1例于34.9个月复发,不能除外第二肿瘤.本组放弃治疗率为10.9％ (12/110),治疗相关死亡率1％ (1/104).中位随访时间为27.9个月(4.2 ～51.5个月),2年无事件生存率(EFS)为(76.0±4.3)％.联合利妥昔单抗治疗组和单纯化疗组的2年EFS差异无统计学意义[分别为(76.1±4.8)％和(75.9±9.6)％,P＞0.05].LDH＜正常值2倍,2～4倍和＞4倍患儿的2年EFS分别为(84.5±4.8)％、(70.6±11.1)％、(58.0±10.1)％(P=0.02).Ⅰ、Ⅱ、Ⅲ以及Ⅳ期/B-ALL患儿的2年EFS分别为100％、(93.3±6.4)％、(75.1±5.4)％和(52.5±13.1)％(P=0.03).结论 国内多中心研究需进一步建立病例分期、分组及病理中央复核制度,并推行淋巴瘤登记制度.提高LDH＞正常值4倍、Ⅳ期和B-ALL晚期患儿的生存率是下一期方案研究的重点.
目的 探討兒童成熟B細胞非霍奇金淋巴瘤(B-NHL)診治方案(CCCG-B-NHL 2010)的療效,為進一步改善多中心協作管理模式和方案改進提供依據.方法 8箇醫療單位參與此項迴顧性研究.收集2009年4月1日至2012年3月31日收治的年齡≤18歲的初治B-NHL和成熟B細胞型急性淋巴細胞白血病(B-ALL)病例,最後隨訪時間為2014年1月31日.104例患兒均按照CCCG-B-NHL 2010方案進行治療.其中23例患兒在CCCG-B-NHL 2010基礎上聯閤利妥昔單抗治療.分析患兒臨床特徵、治療結果,併應用Kaplan-Meier法對患兒進行生存分析.結果 104例患兒中男79例,女25例,中位年齡6.1歲(1.8～15.1歲).其中Ⅰ期2例,Ⅱ期22例,Ⅲ期65例,Ⅳ期9例,B-ALL 6例.單純化療組(81例)和聯閤利妥昔單抗組(23例)在疾病分期和乳痠脫氫酶(LDH)水平分佈上差異均無統計學意義(x2 =1.44和3.99,P均＞0.05).本組6例患兒病情未緩解併進展至死亡,12例複髮,其中11例複髮時間6.9箇月(3.1 ～23.4箇月),另1例于34.9箇月複髮,不能除外第二腫瘤.本組放棄治療率為10.9％ (12/110),治療相關死亡率1％ (1/104).中位隨訪時間為27.9箇月(4.2 ～51.5箇月),2年無事件生存率(EFS)為(76.0±4.3)％.聯閤利妥昔單抗治療組和單純化療組的2年EFS差異無統計學意義[分彆為(76.1±4.8)％和(75.9±9.6)％,P＞0.05].LDH＜正常值2倍,2～4倍和＞4倍患兒的2年EFS分彆為(84.5±4.8)％、(70.6±11.1)％、(58.0±10.1)％(P=0.02).Ⅰ、Ⅱ、Ⅲ以及Ⅳ期/B-ALL患兒的2年EFS分彆為100％、(93.3±6.4)％、(75.1±5.4)％和(52.5±13.1)％(P=0.03).結論 國內多中心研究需進一步建立病例分期、分組及病理中央複覈製度,併推行淋巴瘤登記製度.提高LDH＞正常值4倍、Ⅳ期和B-ALL晚期患兒的生存率是下一期方案研究的重點.
목적 탐토인동성숙B세포비곽기금림파류(B-NHL)진치방안(CCCG-B-NHL 2010)적료효,위진일보개선다중심협작관리모식화방안개진제공의거.방법 8개의료단위삼여차항회고성연구.수집2009년4월1일지2012년3월31일수치적년령≤18세적초치B-NHL화성숙B세포형급성림파세포백혈병(B-ALL)병례,최후수방시간위2014년1월31일.104례환인균안조CCCG-B-NHL 2010방안진행치료.기중23례환인재CCCG-B-NHL 2010기출상연합리타석단항치료.분석환인림상특정、치료결과,병응용Kaplan-Meier법대환인진행생존분석.결과 104례환인중남79례,녀25례,중위년령6.1세(1.8～15.1세).기중Ⅰ기2례,Ⅱ기22례,Ⅲ기65례,Ⅳ기9례,B-ALL 6례.단순화료조(81례)화연합리타석단항조(23례)재질병분기화유산탈경매(LDH)수평분포상차이균무통계학의의(x2 =1.44화3.99,P균＞0.05).본조6례환인병정미완해병진전지사망,12례복발,기중11례복발시간6.9개월(3.1 ～23.4개월),령1례우34.9개월복발,불능제외제이종류.본조방기치료솔위10.9％ (12/110),치료상관사망솔1％ (1/104).중위수방시간위27.9개월(4.2 ～51.5개월),2년무사건생존솔(EFS)위(76.0±4.3)％.연합리타석단항치료조화단순화료조적2년EFS차이무통계학의의[분별위(76.1±4.8)％화(75.9±9.6)％,P＞0.05].LDH＜정상치2배,2～4배화＞4배환인적2년EFS분별위(84.5±4.8)％、(70.6±11.1)％、(58.0±10.1)％(P=0.02).Ⅰ、Ⅱ、Ⅲ이급Ⅳ기/B-ALL환인적2년EFS분별위100％、(93.3±6.4)％、(75.1±5.4)％화(52.5±13.1)％(P=0.03).결론 국내다중심연구수진일보건립병례분기、분조급병리중앙복핵제도,병추행림파류등기제도.제고LDH＞정상치4배、Ⅳ기화B-ALL만기환인적생존솔시하일기방안연구적중점.
Objective This study aimed to evaluate the efficacy of the CCCG-B-NHL 2010 protocol in children with mature B-cell non-Hodgkin's lymphoma (B-NHL) in China retrospectively.Method Eight tertiary referral centers for childhood cancer participated in this study.From April 2009 to March 2012,104patients below 18 years with newly diagnosed,untreated B-NHL or mature B cell acute lymphoblastic leukemia (B-ALL) were enrolled.Six patients refused further staging work-up and treatment due to the expense were excluded.Diagnostic slides were not centrally reviewed in this retrospective study.Twentythree of 104 patients got rituximab therapy during the treatment.Result Of the 104 eligible patients (79boys and 25 girls),the median age was 6.1 years (range 1.8-15.1 years).Two patients (1.9％) had stage Ⅰ disease,22 (21.2％) had stage Ⅱ,65 (62.5％) had stage Ⅲ,9 (8.6％) had stage Ⅳ,and 6 (5.8％) had B-ALL.At a median follow-up of 27.9 months (range 4.2-51.5 months),the 2-year probability of event-free survival (EFS) was (76.0 ±4.3)％ in all patients.The 2-year EFS was 100％,(93.3-± 6.4) ％,(75.1 ± 5.4) ％ and (52.5 ± 13.1) ％ for patients with stage Ⅰ,Ⅱ,Ⅲ and Ⅳ/ BALL,respectively (P =0.03).There was no significant difference in EFS between patients treated with chemotherapy only and those with chemotherapy combined with rituximab [(76.1 ± 4.8) ％ vs.(75.9 ±9.6)％,P＞0.05].The2-yearEFS was (84.5±4.8)％,(70.6±11.1)％ and (58.0±10.1)％ for patients with LDH ＜ 2 times the institutional upper limit of normal (2 times NL),2-4 times NL and ＞4 times NL,respectively (P =0.02).Only one patient (1％,1/104) died of treatment-related complications.Six patients refused treatment during therapy.Including the 6 cases who refused to receive further staging diagnostic workup,the abandonment rate for B-NHL/B-ALL was 10.9％ (12/110).Conclusion The EFS rate in this study was much lower in patients with advanced disease (LDH ＞ 4 times NL,stage Ⅳ and B-ALL) than that of series conducted in medically developed countries.Establishment of strategies to improve survival in patient with advanced disease is the priorities in our following study.
