Xiao Pei-fang, Chai Yi-huan, Li Jian-qin, He Hai-long, Wang Yi, Li Zhen-ping, He Ya-xiang, Ji Zheng-hua
Department of Hematology, Affiliated Children's Hospital, Suzhou University, Suzhou 215003, China.
Zhonghua Er Ke Za Zhi. 2005 Jul;43(7):486-9.
With the improvement of the diagnosis and treatment, the complete remission (CR) rate and the survival rate of childhood acute lymphoblastic leukemia have been increased in the recent 10 years. The objective of this study was to analyze the outcomes of 119 standard-risk childhood acute lymphoblastic leukemia (SR-ALL) patients, and explore how to improve the survival rate in ALL.
A total of 119 patients aged 14 months to 15 years were diagnosed as SR-ALL according to the Suggestion of Diagnosis And Treatment for Childhood Acute Leukemia-1993. Among them, seventy-nine were boys and 40 were girls. All of the patients were treated with the CCLG-97 protocol and were followed up for a period of 20 approximately 78 months.
The complete remission rate reached 97.4% in four-week induction. Twenty-one patients were out of follow-up, comprising 63%, 14%, 10%, 8% and 5% of all subjects in 1998, 1999, 2000, 2001 and 2002, respectively. The overall survival rates were 93.3%, 90.2%, 88.0%, 85.0%, 85.0% and 85.0% in 1 year, 2 years, 3 years, 4 years and 5 years, respectively. Relapses occurred in 13 patients (13.8%). Among 9 isolated hematologic relapses, 5 patients (56%) were given irregular therapy, 2 did not reach CR within 4 weeks and relapsed 2 years later, 2 accepted regular therapy, 1 was of hypodiploidy and 1 T-ALL. Isolated central nervous system (CNS) relapse occurred in 4 patients (4.3%). Fifteen patients (12.6%) died, 5 of whom (4.2%) died of complications.
Reinforcing administration and regular therapy are important to improve the long-term survival rate in childhood ALL. The clinical classification should be adjusted with the improvement of diagnostic methods. CCLG-97 protocol decreased the rate of the relapses in SR-ALL and didn't increase the rate of therapy-related death. High-dose methotrexate should be used in therapy and its dosage, usage and individualized therapeutic regimen should be further studied.
随着诊断和治疗水平的提高，近10年来儿童急性淋巴细胞白血病的完全缓解（CR）率和生存率有所提高。本研究旨在分析119例标危儿童急性淋巴细胞白血病（SR-ALL）患者的治疗结果，并探讨如何提高ALL的生存率。
根据《儿童急性白血病诊断与治疗建议-1993》，共119例年龄在14个月至15岁的患者被诊断为SR-ALL。其中，79例为男性，40例为女性。所有患者均采用CCLG-97方案治疗，并随访约78个月，随访时间为20年。
四周诱导缓解率达到97.4%。21例患者失访，分别占1998年、1999年、2000年、2001年和2002年所有研究对象的63%、14%、10%、8%和5%。1年、2年、3年、4年和5年的总生存率分别为93.3%、90.2%、88.0%、85.0%、85.0%和85.0%。13例患者（13.8%）复发。在9例单纯血液学复发中，5例患者（56%）接受了不规则治疗，2例在4周内未达到CR，2年后复发，2例接受了正规治疗，1例为亚二倍体，1例为T-ALL。4例患者（4.3%）发生单纯中枢神经系统（CNS）复发。15例患者（12.6%）死亡，其中5例（4.2%）死于并发症。
加强给药和规范治疗对提高儿童ALL的长期生存率很重要。应随着诊断方法的改进调整临床分类。CCLG-97方案降低了SR-ALL的复发率，且未增加治疗相关死亡率。治疗中应使用大剂量甲氨蝶呤，其剂量、用法及个体化治疗方案有待进一步研究。
