NPCLC-ALL2008方案治疗儿童急性淋巴细胞白血病复发患儿临床特征分析

Children with relapsed acute lymphoblastic leukemia treated by NPCLC-ALL2008 protocol

目的分析中国儿童急性淋巴细胞白血病2008方案(NPCLC-ALL2008)治疗急性淋巴细胞白血病复发患儿的临床特征及预后相关因素。方法回顾性分析2009年1月—2015年12月在浙江大学医学院附属儿童医院血液肿瘤中心接受NPCLC-ALL2008方案进行规范治疗后复发患儿的临床资料。结果共676例患儿接受NPCLC-ALL2008方案规范化疗,包括急性T淋巴细胞白血病(T-ALL)69例和急性前体B淋巴细胞白血病(pB-ALL)607例,复发共82例,其中T-ALL 15例,pB-ALL 67例,8年累计复发率分别为(26±6)%和(13±2)%(χ^(2)=10.329,P=0.001),T-ALL骨髓和中枢神经系统复发率均明显高于pB-ALL。T-ALL复发时间早于pB-ALL,极早期复发分别占73%和36%(χ^(2)=7.050,P=0.008)。骨髓复发的T-ALL患儿再次完全缓解率为38%,8年总生存率(OS)为(12±10)%,均低于pB-ALL[56%和(36±6)%,P>0.05]。复发越早,预后越差,极早期复发、早期复发和晚期复发的8年OS分别为(17±6)%、(40±9)%和(56±14)%,差异有统计学意义(χ^(2)=10.892,P=0.004)。复发时间早和未能再次获得完全缓解对复发后生存有显著影响,相对危险度及95%可信区间分别为2.245(1.292-3.898)和22.480(9.697-52.114)。结论儿童T-ALL复发率明显高于pB-ALL,复发时间明显早于pB-ALL。复发时间早和未能再次获得完全缓解是影响复发后患儿长期生存的独立危险因素。

Objective To compare the differences of the clinical characteristics and prognostic factors between pediatric relapsed acute T lymphoblastic leukemia(T-ALL)and B-cell precursor acute lymphoblastic leukemia(pB-ALL)patients.Methods A retrospective analysis of patients with relapsed ALL who were treated by the National Protocol of Childhood Leukemia in China-Acute Lymphoblastic Leukemia(NPCLC-ALL)2008 protocol was performed.Patients were collected from January 2009 to December 2015 in the Department of Hematology-Oncology,Children′s Hospital of Zhejiang University School of Medicine Results From January 2009 to December 2015,676 patients with newly diagnosed ALL were treated by the NPCLC-ALL2008 protocol,including 69 patients with T-ALL and 607 patients with pB-ALL.82 patients with relapsed ALL were enrolled,including 15 cases of T-ALL and 67 cases of pB-ALL.The 8-year cumulative incidence of relapse in the T-ALL and pB-ALL groups were(26±6)%and(13±2)%,respectively(χ^(2)=10.329,P=0.001).The relapse rates of the bone marrow and the central nervous system in T-ALL patients were significantly higher than those in the pB-ALL patients.The time to relapse was earlier in T-ALL than in pB-ALL,with a very early relapse of 73%and 36%,respectively(χ^(2)=7.050,P=0.008).The complete remission rate was 38%,and the 8-year overall survival rate was(12±10)%in T-ALL patients with bone marrow relapse,which were both lower than those of patients with pB-ALL[56%and(36±6)%,respectively,P>0.05].Time to relapse was a good predictor of outcome in relapsed patients.The 8-year overall survival rates for patients with very early relapse,early relapse and late relapse were(17±6)%,(40±9)%and(56±14)%,respectively(χ^(2)=10.892,P=0.004).Early relapse and fail to achieve complete remission again had significant impact on the survival after the relapse,with the relative risk and 95%confidence interval were 2.245(1.292-3.898)and 22.480(9.697-52.114),respectively.Conclusions The relapse rate in the patients with T-ALL is higher than that of those with pB-ALL.The time to relapse is earlier in T-ALL than in pB-ALL.Early relapse and failure to achieve complete remission again are the independent risk factors for survival after relapse.