Ye Qi-dong, Tang Jing-yan, Pan Ci, Xue Hui-liang, Chen Jing, Zhou Min, Jiang Hua, Luo Chang-ying, Wang Jian-min, Tang Yan-jing, Gu Long-jun
Department of Hematology/Oncology, Shanghai Children's Medical Center, Shanghai Jiaotong University School of Medicine, Shanghai 200127, China.
Zhonghua Xue Ye Xue Za Zhi. 2011 Dec;32(12):840-3.
To explore the incidence, clinical characteristics and prognosis of children and adolescents over 10 years of age with acute lymphoblastic leukemia (ALL).
From May 1, 2005 to April 30, 2009, 67 newly diagnosed ALL children and adolescents over 10 years of age were enrolled in protocol of ALL-2005. All of the clinical characteristics of the patients were analyzed. The statistics was done by SPSS 13.0.
There were 40 males (59.7%) and 27 females (40.3%). The mean age at diagnosis was 12.3 ± 1.7 (10.0 to 17.8) years with median age of 12.2 years. Of 67 patients, 48 were in medium risk group, and 19 in high risk group. During induction therapy, 83.6% and 86.6% patients had good response to prednisone and bone marrow blasts ≤ 5% at day 19, respectively. The overall hematologic response rate in these 67 patients was 88.1% (59) in complete remission (CR) after induction therapy, 15 patients relapsed with mean continuous CR period of (14.9 ± 9.9) months. The five-year event-free survivals (EFS) and overall survivals (OS) were (64.4 ± 6.3)% and (74.1 ± 6.1)%, respectively. According to univariate analysis, elevated serum ferritin, bcr-abl translocation, poor response to prednisone, high bone marrow blasts at day 19 or after induction therapy, and high minimal residual disease (MRD) after induction therapy increased risk for recurrence. Multivariate analysis indicated that high MRD after induction therapy was associated with recurrence (RR = 2.20, 95%CI 1.26 - 3.84, P < 0.01).
Survival has improved for children and adolescents with ALL by ALL-2005 protocol. Analysis of serum ferritin and bcr-abl translocation at diagnosis, early responses to treatment and MRD detection during therapy are powerful prognostic indicators.
探讨10岁以上儿童及青少年急性淋巴细胞白血病（ALL）的发病率、临床特征及预后。
2005年5月1日至2009年4月30日，67例新诊断的10岁以上ALL儿童及青少年纳入ALL - 2005方案。对所有患者的临床特征进行分析。采用SPSS 13.0进行统计学分析。
男性40例（59.7%），女性27例（40.3%）。诊断时的平均年龄为12.3±1.7（10.0至17.8）岁，中位年龄为12.2岁。67例患者中，48例为中危组，19例为高危组。诱导治疗期间，分别有83.6%和86.6%的患者对泼尼松反应良好且在第19天骨髓原始细胞≤5%。这67例患者诱导治疗后完全缓解（CR）的总体血液学缓解率为88.1%（59例），15例复发，平均持续CR期为（14.9±9.9）个月。五年无事件生存率（EFS）和总生存率（OS）分别为（64.4±6.3）%和（74.1±6.1）%。单因素分析显示，血清铁蛋白升高、bcr - abl易位、对泼尼松反应不佳、第19天或诱导治疗后骨髓原始细胞高以及诱导治疗后微小残留病（MRD）高增加复发风险。多因素分析表明，诱导治疗后高MRD与复发相关（RR = 2.20，95%CI 1.26 - 3.84，P < 0.01）。
ALL - 2005方案使ALL儿童及青少年的生存率得到提高。诊断时血清铁蛋白和bcr - abl易位分析、治疗早期反应及治疗期间MRD检测是有力的预后指标。
