CAMSBDH-ALL方案治疗儿童急性淋巴细胞白血病的中长期疗效观察

Long-term efficacy of CAMSBDH-ALL chemotherapy protocol for the treatment of childhood acute lymphoblastic leukemia

摘要:

目的 回顾性分析CAMSBDH-ALL 方案治疗儿童急性淋巴细胞白血病（ALL）的中长期疗效。方法 1999 年1 月至2007 年12 月间初诊儿童ALL 共318 例，2002 年12 月前收治的83 例患儿采用CAMSBDH-ALL99 方案治疗，其中标危（SR）患儿48 例，高危（HR）患儿35 例；之后收治的235 例患儿采用CAMSBDH-ALL03 方案，其中SR 患儿131 例，HR 患儿104 例。99 方案采用传统化疗；03 方案在99 方案的基础上进行调整。结果 03 方案组中长期OS 率及EFS 率均明显高于99 方案组 （均P<0.01）；SR 及HR 患儿03方案组中长期OS 率及EFS 率亦均显著高于99 方案组（均P<0.01）；03 方案组复发率（28.9%）显著低于99方案组（50.6%）（P<0.05），且病死率（28.5%）亦显著低于99 方案组（56.6%）（P<0.05）。结论 03 方案疗效明显优于99 方案，即能明显降低ALL 患儿复发率和病死率，提高患儿中长期生存率。

Abstract:

Objective To study the long-term efficacy of CAMSBDH-ALL chemotherapy protocol for the treatment of childhood acute lymphoblastic leukemia (ALL). Methods Three hundred and eighteen children who were newly diagnosed with ALL between January 1999 and December 2007 were enrolled in this study. Among the 318 children, 83 children who hospitalized before December 2002 were treated with CAMSBDH-ALL99 protocol, including 48 patients of standard risk and 35 patients of high risk. The patients (n=235; 131 in standard risk and 104 in high risk) who hospitalized after December 2002 were treated with CAMSBDH-ALL03 protocol. Patients in the CAMSBDHALL99 protocol group were treated with conventional chemotherapy. CAMSBDH-ALL03 protocol was modified based on the CAMSBDH-ALL99 protocol. Results The long-term overall survival (OS) and event-free-survival (EFS) in the CAMSBDH-ALL03 group was significantly higher than in the CAMSBDH-ALL99 (P<0.01). The long-term OS and EFS of standard risk and high risk patients in the CAMSBDH-ALL03 protocol group were significantly higher than in the CAMSBDH-ALL99 protocol group (P<0.01). The CAMSBDH-ALL03 protocol group showed a significantly lower recurrence rate (28.9%) than in the CAMSBDH-ALL99 protocol group (50.6%) (P<0.05). The mortality rate in the CAMSBDH-ALL03 protocol group was 28.5% vs 56.6% in the CAMSBDH-ALL99 protocol group (P<0.05). Conclusions The therapeutic effect of the CAMSBDH-ALL03 protocol is supior to the CAMSBDH-ALL99 protocol group for childhood ALL, with a higher long-term survival rate.