CCLG-ALL2008方案治疗儿童急性淋巴性白血病单中心疗效分析

The efficacy of CCLG-ALL2008 protocol in treating childhood acute lymphoblastic leukemia-a single center experience

目的分析CCLG—ALL2008方案治疗儿童急性淋巴细胞白血病（ALL）的单中心疗效，为改进该方案提供临床依据。方法符合入组标准的100例ALL患儿，接受了CCLG．ALL2008方案治疗，回顾性分析治疗结果及治疗相关毒副作用。结果100例中低危ALL49例，中危23例，高危28例。诱导缓解率97％。化疗期间发生严重感染24例（24％），并发大脑后部可逆性脑病综合征（PRES）6例，发生治疗相关死亡（TRM）8例。本组病人的2年和5年累积复发率均为（12％±0．04），2年和5年总体生存率（0s）均为（83％±0．04），2年和5年无事件生存率（EFS）均为（79％±0．04）。低危组与高危组间Os差异有显著性（χ2=12．026，P=0．001）；低危组与高危组间EFS差异有显著性（χ2=14．291，P=0．000），中危组与高危组间EFS差异亦有显著性（χ2=5．356，P=0．021）。影响生存的主要因素是诱导期严重感染所致TRM、疾病复发以及病人治疗途中失访。结论CCLG—ALL2008方案治疗儿童ALL完全缓解率高、复发率低，降低诱导期严重感染所致TRM，减少高危疾病复发，并改进高危病人综合管理以使病人能接受完整治疗，可进一步提高生存率。

Objective To analyze the efficacy of CCLG-ALL2008 protocol in treating childhood acute lymphoblastic leukemia（ALL） in our single center. Methods A total of 100 eligible children with ALL were enrolled in this study, they were treated with CCLG-ALL 2008 protocol. We analyzed retrospectively the treatment outcomes and treatment related toxic and adverse effects. Results Of 100 cases,49 were assessed as low risk patients, 23 as moderate risk, 28 as high risk. The overall complete remission （CR） rate was 97% at the end of induction period. There were 24 patients （24%） complicated with severe infection during chemotherapy. Posterior reversible encephalopathy syndrome （PRES） had been observed in 6 patients. A total of 8 patients died from treatment related mortality （TRM）. The 2-year and 5-year cumulative relapse rate were all 12% ±0.04. The 2-year and 5-year overall survival （OS） rate were all 83% ±0.04. The 2-year and 5-year event-free survival（EFS） rate were all 79% ＋0.04. The difference of OS between low risk group and high risk group was significant （χ2 = 12. 026,P =0.001 ）. Thedifference of EFS between low risk group and high risk group was significant（χ2 = 14.291 ,P =0.000） ; the difference of EFS between moderate risk group and high risk group was also significant （χ2 = 5. 356, P =0.021 ）. The main causes affecting survival were TRM resulted by severe infection during induction period, disease relapse and patients lost to follow up. Conclusions The treatment of childhood ALL according to CCLG-ALL 2008 protocol has a high CR rate with low relapse. We expect to improve survival by decreasing TRM from severe infection during induction period, preventing disease relapse of high risk patients and improving comprehensive management of high risk patients.