上海交通大学学报（医学版）

上海交通大学学报（医学版）

• 论著（临床研究） • 上一篇    下一篇

多中心治疗儿童急性T淋巴细胞性白血病的长期疗效评价及随访报告

汤梦婕1，袁晓军1，汤静燕2，沈树红2，孙立荣3，蒋 慧4，王宁玲5   

  1. 1.上海交通大学医学院附属新华医院儿童血液/肿瘤科， 上海 200092; 2.上海交通大学医学院附属儿童医学中心血液/肿瘤科， 上海 200127; 3.青岛大学附属医院儿科， 青岛 266003; 4.上海交通大学医学院附属儿童医院血液科， 上海 200040； 5.安徽医科大学第二附属医院儿科， 合肥 230601
  • 出版日期:2014-11-28 发布日期:2014-12-02
  • 通讯作者: 袁晓军, 电子信箱: xhxjyuan@hotmail.com。
  • 作者简介:汤梦婕（1988—）， 女， 硕士生; 电子信箱: shtmj@sina.com。
  • 基金资助:

    上海市教委科研创新重点项目（09ZZ115）

Evaluation of long-term therapeutic effects of children with T cell acute lymphoblastic leukemia of multiple medical centers and the follow-up report

TANG Meng-jie1,YUAN Xiao-jun1, TANG Jing-yan2, SHEN Shu-hong2, SUN Li-rong3, JIANG Hui4, WANG Ning-ling5   

  1. 1.Department of Pediatric Hematology/Oncology, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200092, China; 2.Department of Pediatric Hematology/Oncology, Children's Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai 200127, China; 3.Department of Pediatrics, the Affiliated Hospital of Qingdao University, Qingdao 266003, China; 4.Department of Pediatric Hematology, Children’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200040, China; 5.Department of Pediatrics, the Second Affiliated Hospital of Anhui Medical University, Hefei 230601, China
  • Online:2014-11-28 Published:2014-12-02
  • Supported by:

    InnovationProgramofShanghaiMunicipalEducationCommittee, 09ZZ115

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摘要：

目的 评估急性淋巴细胞白血病（ALL）-2005方案对儿童T淋巴细胞白血病（T-ALL）的临床疗效。方法 收集源自5所儿童血液病治疗中心的2005年5月1日—2009年9月30日初次发病,并纳入ALL-2005方案治疗的53例T-ALL患儿的临床资料，患儿分别按照中危和高危进行分组后接受不同强度的化疗。回顾性分析诱导缓解率、治疗相关并发症及随访情况，采用Kaplan-Meier生存分析法对T-ALL预后的影响因素进行分析。结果 53例T-ALL患儿，剔除1例患儿（确诊后2d因弥散性血管内凝血死亡），男44例，女8例；诊断中位年龄为8.1岁，年龄≥10岁的患儿16例(19.2%)；外周血白细胞计数≥50×109/L的患儿35例（67.3%)。治疗后第35日的诱导缓解率为88.5%；复发病例为7例（13.5%），复发中位时间为8.3个月，其中骨髓复发4例，中枢神经系统复发3例。随访中位时间为62.0个月；8年总体生存率为（82.6±5.2）%，其中中危组为（91.1±3.2）%，高危组为（51.5±13.7）%，两组间差异有统计学意义（P＜0.0001）；8年无事件生存率为（68.4±6.1）%，中危组和高危组分别为（74.6±5.8）%和（36.9±12.9）%，两组间差异有统计学意义（P＜0.000 1）。结论 ALL-2005方案治疗儿童T-ALL可获得较好疗效。诱导期是否获得完全缓解以及危险度分组是影响预后的独立因素。

关键词: 白血病, T淋巴细胞, 儿童, 联合化疗, 多中心

Abstract:

Objective To evaluate the clinical effects of ALL-2005 protocol on children with T lymphocyte acute lymphoblastic leukemia (T-ALL). Methods Clinical data of 53 patients with T-ALL from five Children's Medical Centers of Hematology/Oncology between 1st May 2005 and 30th September 2009 were selected and treated by the ALL-2005 protocol. All patients underwent the chemotherapy of different dose intensity according to their risk levels (medium risk or high risk). The remission rate of induction, complications relevant to the treatment, and follow-up results were retrospectively analyzed. Factors influencing the prognosis of T-ALL were analyzed by the Kaplan-Meier survival analysis. Results Among 52 patients (excluding one patient who died of disseminated intravascular coagulation two days after diagnosis), 44 of them were males and 8 were females. The median age of diagnosis was 8.1 years old and 16 cases (19.2%) were over 10 years old. The white blood cell count of 35 patients (67.3%) was higher than or equal to 50×109/L. The remission rate of induction was 88.5% on the 35th day after treatment. Seven cases (13.5%) relapsed and the median relapse time was 8.3 months. Among 7 cases, 4 cases suffered from bone marrow relapse and 3 cases suffered from central nervous system relapse. The median follow-up time was 62.0 months. The 8-year overall survival rates of all patients, medium risk group, and high risk group were (82.6±5.2)%, (91.1±3.2)% and (51.5±13.7)%. The difference of two groups was statistically significant (P<0.000 1). The 8-year event-free survival rates of all patients, medium risk group, and high risk group were (68.4±6.1)%, (74.6±5.8)%, and (36.9±12.9)%. The difference of two groups was statistically significant (P<0.0001). Conclusion ALL-2005 protocol achieves good clinical outcome for children with T-ALL. Complete remission during the induction period and risk-based grouping are independent factors that influence the prognosis of T-ALL.

Key words: leukemia, T lymphocyte, children, combination chemotherapy, multi-center