CCLG-ALL2008方案治疗10岁以上儿童及青少年急性淋巴细胞白血病的疗效分析

Clinical effect of CCLG-ALL2008 regimen in treatment of children and adolescents aged > 10 years with acute lymphoblastic leukemia

摘要:

目的 探讨CCLG-ALL2008方案治疗10岁以上儿童及青少年初诊急性淋巴细胞白血病（ALL）的长期疗效。方法 收集2008年4月至2015年4月采用CCLG-ALL2008方案治疗的150例10岁以上ALL患儿的临床资料，采用Kaplan-Meier生存分析评估患儿总体生存（OS）率和无事件生存（EFS）率。结果 150例患儿中，男87例（58.0%），女63例（42.0%），中位年龄11（10~15）岁；中危患儿84例（56.0%），高危患儿66例（44.0%）；B-ALL患儿122例（81.3%），T-ALL患儿28例（18.7%）；融合基因检测阳性51例（34.0%），其中BCR-ABL阳性16例（31%），TEL-AML1阳性11例（22%），E2A-PBX1阳性8例（16%），其他基因阳性16例（31%）。采用CCLG-ALL2008方案治疗1个疗程完全缓解率为96.0%（144/150）。150例患儿中位随访时间为52（3~122）个月，5年OS率为79.0%±3.5%，5年EFS率为67.3%±4.1%。中危患儿和高危患儿，以及B-ALL患儿和T-ALL患儿间5年OS率及5年EFS率比较，差异均无统计学意义（P > 0.05）。诱导治疗结束时骨髓达完全缓解患儿的5年OS率及5年EFS率均高于骨髓未达完全缓解者（P < 0.05）。结论 10岁以上儿童及青少年ALL患儿采用CCLG-ALL2008方案治疗，其完全缓解率高，5年OS率及EFS率均较高。诱导治疗后未达到完全缓解患儿预后不良。

Abstract:

Objective To study the long-term clinical effect of CCLG-ALL2008 regimen in the treatment of children and adolescents, aged > 10 years, with newly diagnosed acute lymphoblastic leukemia (ALL). Methods A retrospective analysis was performed for the clinical data of 150 ALL children and adolescents aged > 10 years who were treated with CCLG-ALL2008 regimen from April 2008 to April 2015. The Kaplan-Meier method was used to analyze overall survival (OS) rate and event-free survival (EFS) rate. Results Among the 150 children and adolescents, there were 87 (58.0%) boys and 63 (42.0%) girls, with a median age of 11 years (range 10-15 years). Of the 150 children and adolescents, 84 (56.0%) had intermediate risk and 66 (44.0%) had high risk; 122 (81.3%) had B-lineage acute lymphoblastic leukemia (B-ALL) and 28 (18.7%) had T-lineage acute lymphoblastic leukemia (T-ALL). The fusion gene test yielded positive results in 51 children and adolescents (34.0%), among whom 16 (31%) had positive BCR-ABL, 11 (22%) had positive TEL-AML1, 8 (16%) had positive E2A-PBX1, and 16 (31%) were positive for other fusion genes. The complete remission rate was 96.0% (144/150) after one course of treatment with CCLG-ALL2008 regimen. The median follow-up time was 52 months (range 3-122 months). The 5-year OS rate was 79.0%±3.5%, and the 5-year EFS rate was 67.3%±4.1%. There were no significant differences in 5-year OS and EFS rates between the children with intermediate or high risk, as well as between the children with B-ALL or T-ALL (P > 0.05). The children and adolescents who achieved complete remission of bone marrow at the end of induction therapy had significantly higher 5-year OS and EFS rates than those who did not achieve complete remission (P < 0.05). Conclusions In ALL children and adolescents aged > 10 years, CCLG-ALL2008 regimen can help to achieve high complete remission rate, 5-year OS rate and 5-year EFS rate. The children and adolescents failing to achieve complete remission at the end of induction therapy tend to have a poor prognosis.