Department of Pediatrics, Aichi Medical University, Aichi, Japan.
Leukemia. 2010 Feb;24(2):335-44. doi: 10.1038/leu.2009.259. Epub 2009 Dec 17.
We analyzed the long-term outcomes of 1021 patients with acute lymphoblastic leukemia (ALL), enrolled in four successive clinical trials (ALL811, ALL841, ALL874 and ALL911) between 1981 and 1993. All patients received risk-adopted therapy according to leukocyte count and age at the time of diagnosis. The median follow-up durations of the four studies were 17.8 years in ALL811, 15.5 years in ALL841, 11.9 years in ALL874 and 15.8 years in ALL911. Patients' event-free survival (EFS) and overall survival (OS) rates at 12 years were 41.0 and 54.3% in ALL811, 50.2 and 60.2% in ALL841, 57.3 and 64.7% in ALL874, and 63.4 and 71.7% in ALL911, respectively. Thus, cure can become a reality for about 70% of children with ALL. There is, however, still a significant difference in survival outcomes according to risk group. Late effects were observed in 70 patients out of 834 (8.4%); hepatitis and short stature were most commonly reported. Reduction of late adverse effects for all patients and development of new treatment strategies for very-high-risk patients are major issues for upcoming trials to address.
我们分析了 1021 例急性淋巴细胞白血病（ALL）患者的长期结果，这些患者分别纳入了 1981 年至 1993 年期间进行的四项连续临床试验（ALL811、ALL841、ALL874 和 ALL911）。所有患者均根据白细胞计数和诊断时的年龄接受了风险适应性治疗。四项研究的中位随访时间分别为 ALL811 为 17.8 年，ALL841 为 15.5 年，ALL874 为 11.9 年，ALL911 为 15.8 年。患者 12 年时的无事件生存（EFS）和总生存（OS）率分别为 ALL811 为 41.0%和 54.3%，ALL841 为 50.2%和 60.2%，ALL874 为 57.3%和 64.7%，ALL911 为 63.4%和 71.7%。因此，约 70%的 ALL 患儿可以治愈。然而，根据风险组，生存结果仍存在显著差异。在 834 例患者中有 70 例（8.4%）出现了晚期效应；最常见的报告是肝炎和身材矮小。减少所有患者的晚期不良影响并为极高危患者开发新的治疗策略是即将进行的试验需要解决的主要问题。
