中国儿童复发急性淋巴细胞白血病应用VDMP方案再诱导的安全性和有效性的评估——江苏小儿血液协作组报告

Safety and Efficacy of VDMP Re-induction Regimen in Chinese Children with Relapsed Acute Lymphoblastic Leukemia——A Report from Jiangsu Childhood Hematology Group

目的:观察VDMP方案诱导治疗儿童复发急性淋巴细胞白血病的疗效及安全性。方法:应用VDMP方案治疗41例急性淋巴细胞白血病骨髓复发患儿,分析其治疗效果及不良反应。结果:41例患儿中:男27例,女14例,年龄2.2岁-15.4岁,中位年龄7.9岁。极早期复发7例,早期复发11例,晚期复发23例。免疫分型显示,B淋巴细胞型38例,T淋巴细胞型3例。化疗中及化疗后发生感染40例,发生率97.6%,其中因严重感染死亡1例。所有患儿均出现4级中性粒细胞减少,39例(95.1%)出现3级或3级以上非血液学不良反应事件。41例中38例患儿完成VDMP化疗,其结果完全缓解34例,部分缓解1例,未缓解3例,缓解率89.5%。随访结果表明,38例完成化疗的患儿中共37例有完整随访资料,其中16例接受异基因造血干细胞移植,现存活13例,21例继续化疗,存活8例,移植患儿生存率高于未移植患儿(P<0.05)。结论:VDMP方案治疗儿童复发急性淋巴细胞白血病缓解率高,疗效确切,不良反应可控。达到再次缓解后的患儿应接受造血干细胞移植。

Objective： To evaluate the therapeutic safety and efficacy of VDMP re-induction regimen in Chinese children with relapsed acute lymphoblastic leukemia（ALL）. Methods： Forty-one patients with relapsed ALL were prospectively enrolled in this study. All the patients were distributed in 3 children＇s hospitals and treated with VDMP regimen as the first re-induction chemotherapy. Therapeutic efficacy and side-effects were analyzed. Results： The ratio of male to female was 27：14. The median age was 7.9（2.2-15.4） years old. Patients relapsed at very early, early, and late stage were 7 cases, 11 cases, and 23 cases, respectively. The immunophenotype analysis showed that 38 cases were B-ALL,and 3 cases were T-ALL. All patients suffered from grade 4 of neutropenia and forty（97.6%） cases got infection, of them one case died. Thirty-nine（95.1%） cases had nonhematologic adverse event at least one organ involved grade 3 in 38 out of 41 cases, the VDMP therapy was completed, 34（89.5%） cases achieved a complete remission（CR）, 1 case achieved partial remission（PR）, and 3 cases didn＇t get remission. Follow-up data of 38 cases with completing VDMP chemotherapy were obtained, only one case was lost. Among 37 cases available for evaluation, 16 cases received allo-hematopoietic stem cell transplantation（allo-HSCT） after chemotherapy, and 13 patients survived, while 21 cases did not receive alloHSCT（treated with chemotherapy only）, and 8 patients survived. The overall survival rate of allo-HSCT group was significantly higher than that of those treated with chemotherapy only（P〈0.05）. Conclusion： VDMP re-induction regimen is effective and well tolerable for pafients in the treated children with relapsed ALL. After remission, allo-HSCT is recommended with the aim of long survival.