NHL-2010方案治疗儿童淋巴母细胞淋巴瘤临床疗效及安全性分析

Efficacy and Safety of NHL-2010 Protocol in Treating Lymphoblastic Lymphoma in Children

目的:探讨非霍奇金淋巴瘤(non-Hodgkin’s lymphoma,NHL)-2010方案治疗儿童淋巴母细胞淋巴瘤(lymphoblastic lymphoma,LBL)的疗效及安全性。方法:回顾性分析2009年8月至2013年12月四川大学华西第二医院确诊的20例LBL患儿的临床和实验室资料,按照儿童LBL化疗方案(NHL-2010)进行治疗。LBL患儿总体生存率(overall survival,OS)及无事件生存率(event-free survival,EFS)的计算采用Kaplan-Meier方法计算。结果:20例患儿入组,男17例,女3例,男女比例为5.7∶1;中位发病年龄8.8岁(2.3~14.3岁)。T细胞型12例(60.0%),B细胞型8例(40.0%)。Ⅰ期2例(10.0%,2/20),Ⅱ期1例(5.0%,1/20),Ⅲ期12例(60.0%,12/20),Ⅳ期5例(25.0%,5/20)。随访至2015年6月30日,中位随访时间为34.8月(2.4~67.4月),3年OS为85.0%,EFS为80.0%。3例发生死亡,其中2例复发,均为骨髓复发;1例发生脓毒血症,病原菌为坐皮肤球菌,治疗相关死亡率5.0%。结论:本组患儿采用NHL-2010方案治疗,疗效接近国内报道最佳水平,而治疗相关死亡1例,安全性较高。由于我国儿童LBL的诊治水平仍落后于国际水平,因此,仍有待进一步完善医疗体制,加强疾病宣教,以及提高患儿及其家属治疗依从性,并且增强国内各治疗中心间的协作。

Objective:To evaluate the efficacy and safety of non-Hodgkin’s lymphoma(NHL)-2010 protocol in treating lymphoblastic lymphoma(LBL)in children.Methods:Clinical data of 20 newly diagnosed children with LBL from August 2009 to December 2013 in our hospital was retrospectively analyzed.Patients were treated with NHL-2010,a chemotherapy protocol.Kaplan-Meier method was used to estimate overall survival(OS)and event-free survival(EFS)of patients.Results:A total of 20 cases were recruited,with 17 males and 3 females(M:F=5.7∶1),and 12(60.0%)Tcell LBL and 8(40.0%)B-cell LBL,respectively.The median age at diagnosis was 8.8(2.3-14.3)years.According to St.Jude staging classification,2 patients(10.0%)were in stageⅠ,1(5.0%)in stageⅡ,12(60.0%)in stageⅢand 5(25%)in stageⅣ.3-year OS was 85.0%±8.0%,and EFS was 80.0%±8.9%(follow-up up until June 30,2015).Within the 3 dead cases,2 died of relapse,while 1 died of severe sepsis(pathogen:Kocuria kristinae;mortality 5.0%).Conclusion:The NHL-2010 protocol adopted in our study achieved domestically optimal efficacy with only 1 dead case,which is verified to be a relatively safe therapy.However,the diagnosis and treatment of children with LBL still lags behind the international level.Therefore,it is still necessary to further modify treatment protocols,promote disease-related education,improve the compliance of children and their family members,and enhance the collaboration between treatment centers in China.