Matsuzaki A, Ishii E, Nagatoshi Y, Eguchi H, Koga H, Yanai F, Inada H, Nibu K, Tamai Y, Akiyoshi K, Nakayama H, Hara T, Take H, Miyazaki S, Okamura J
Division of Child Health, School of Health Sciences, Kyushu University, Fukuoka, Japan.
Int J Hematol. 2001 Apr;73(3):369-77. doi: 10.1007/BF02981964.
We analyzed the long-term outcome and late effects of treatment in 187 patients with childhood acute lymphoblastic leukemia (ALL) diagnosed between 1984 and 1990. Overall survival and event-free survival rates were 68.2% +/- 3.7% and 63.2% +/- 3.6% at 15 years, respectively. Of 55 patients who relapsed after achieving the first complete remission (CR), only 17.4% were rescued by salvage therapy. The advantage of stem cell transplantation over chemotherapy was observed only in those patients with bone marrow relapse during therapy. The SD for score height in patients maintaining the first CR significantly decreased at the time of final follow-up compared with that at diagnosis: 0.059 to -0.800 (P < .0001). The decrease was remarkable in patients younger than 5 years at diagnosis. Other late effects included mild liver dysfunction in 18% and hepatitis C virus infection in 9%. Congestive heart failure was observed in only 2.9% of patients despite the high cumulative dose of daunorubicin (450 mg/m2). Although the survival rates of patients on our protocols were comparable to those of other study groups, some modification, including reduction in dose of cranial irradiation and/or anticancer drugs, should be considered to reduce late adverse effects in survivors of childhood ALL.
我们分析了1984年至1990年间确诊的187例儿童急性淋巴细胞白血病（ALL）患者的长期预后及治疗的晚期效应。15年时的总生存率和无事件生存率分别为68.2%±3.7%和63.2%±3.6%。在首次完全缓解（CR）后复发的55例患者中，只有17.4%通过挽救治疗得以挽救。仅在治疗期间出现骨髓复发的患者中观察到干细胞移植优于化疗。与诊断时相比，维持首次CR的患者在最后随访时身高评分的标准差显著降低：从0.059降至-0.800（P<0.0001）。诊断时年龄小于5岁的患者下降明显。其他晚期效应包括18%的患者出现轻度肝功能不全，9%的患者感染丙型肝炎病毒。尽管柔红霉素累积剂量较高（450mg/m²），但仅2.9%的患者出现充血性心力衰竭。虽然我们方案治疗的患者生存率与其他研究组相当，但应考虑进行一些调整，包括降低颅脑照射剂量和/或抗癌药物剂量，以减少儿童ALL幸存者的晚期不良反应。
