小儿“非高危型”急性淋巴细胞白血病降低强度的规范化治疗

Treatment with reduced intensity for non-high risk acute lymphoblastic leukemia of children

目的了解"非高危型"急性淋巴细胞性白血病(ALL)患儿降低治疗强度的可行性。方法选取2007年1月至2012年2月期间应用改良Dutch ALLⅥ方案治疗35例"非高危型"ALL患儿为治疗组,选取同期应用改良IC-2002-ALL方案治疗的"标危组"ALL患儿112例为对照组,比较两组患儿的诱导缓解率、3年无事件生存率、感染病死率、复发率指标和病人的住院治疗费用。结果 35例治疗组患儿诱导缓解率100%;3年无事件生存率85.71%;感染病死率2.86%;复发率11.43%;无失访病例;总治疗失败率14.29%;每位患儿平均住院次数8.60±2.40次;平均每次住院费用4 486.78±2 358.42元。112例对照组患儿诱导缓解率100%,3年无事件生存率60.71%;感染病死率7.14%;复发率7.14%;失访率25.00%;总治疗失败率39.29%;每位患儿平均住院次数9.80±3.90次;平均每次住院费用6 137.93±3 597.23元。两组患儿复发率差异无统计学差异(χ2=0.65,P>0.05);3年无事件生存率,感染病死率和总治疗失败率差异均有统计学意义(χ2值分别为7.50、4.22、5.78,均P<0.05);两组患儿平均每次治疗费用差异无统计学意义(t=1.83,P>0.05);平均住院次数差异有统计学意义(t=2.09,P<0.05)。结论改良Dutch ALLⅥ方案治疗"非高危型"急性淋巴细胞白血病初步结果安全可行,疗效满意,费用低廉。

Objective To understand the feasibility of reducing intensity of treatment for ＂non-high risk＂acute lymphoblastic leukemia（ ALL） of children. Methods Altogether 35＂non-high risk＂ALL children treated with modified Dutch ALL Ⅵ Protocol from January 2007 to February 2012 were selected in treatment group and 112 ＂standard risk＂ALL children treated with improved protocol of IC-2002-ALLin the same period were selected in control group. Induced remission rate,three year event-free survival rate,mortality rate of infection,recurrence rate and patient＇s hospitalization expenses were compared between two groups. Results For 35 cases in the treatment group,induced remission rate was 100%,3 year event-free survival rate was 85. 71%,infection mortality rate was 2. 86%,and recurrence rate was 11. 43%. None patient was lost in follow-up,and overall treatment failure rate was 14. 29%. Average hospitalization time of each child was 8. 60 ± 2. 40 times. Average cost of hospitalization was 4 486. 78 ± 2 358. 42 Yuan RMB. For 112 cases in the control group,induced remission rate was 100%,3 year event-free survival rate was 60. 71%,infection mortality rate was 7. 14%,recurrence rate was7. 14%,missed follow-up rate was 25. 00%,and total treatment failure rate was 39. 29%. Average hospitalization time of each child was9. 80 ± 3. 90 times; and average cost for hospitalization was 6 137. 93 ± 3 597. 23 Yuan RMB. Difference in recurrence rate between two groups had no statistical significance（ χ2= 0. 65,P 〉0. 05）,but 3 year event-free survival rate,infection mortality rate and total treatment failure rate of two groups were significantly different（ χ2value was 7. 50,4. 22 and 5. 78,respectively,all P 〈0. 05）. Average cost for hospitalization of two groups had no significant difference（ t = 1. 83,P 〉0. 05）,while difference in average hospitalization time between two groups had statistical significance（ t = 2. 09,P〈 0. 05）. Conclusion Modified Dutch ALLⅥ Protocol for ＂non high-risk＂ALL is safe and feasible. Curative effect is satisfactory and cost is low.