Lee Jae Wook, Kim Seong-Koo, Jang Pil-Sang, Jeong Dae-Chul, Chung Nack-Gyun, Cho Bin, Kim Hack-Ki
Division of Hematology and Oncology, Department of Pediatrics, The Catholic University of Korea, Seoul, Korea.
Pediatr Blood Cancer. 2016 Nov;63(11):1966-73. doi: 10.1002/pbc.26136. Epub 2016 Jul 27.
Recent studies indicate 70-80% event-free survival (EFS) for pediatric acute lymphoblastic leukemia (ALL). In this study, we report the outcome of 295 children and adolescents treated at our institution, with stratification into four risk groups, and omission of cranial irradiation in all patients.
Patients were diagnosed from January 2005 to December 2011 and classified and treated as low, standard, high, and very high risk groups. A delayed intensification phase was given twice for high and very high risk groups. None of the patients received cranial irradiation for central nervous system (CNS) prophylaxis.
The 10-year EFS and overall survival (OS) were 78.5 ± 2.5% and 81.9 ± 2.7%, respectively. EFS according to risk group was as follows: low risk 91.2 ± 3.7%, standard risk 98.1 ± 1.9%, high risk 81.5 ± 4.3%, very high risk 59.4 ± 5.3%. In a multivariate analysis, high hyperdiploidy and infant ALL were significant predictors of EFS. Cumulative incidence of any relapse, isolated CNS relapse, and any CNS relapse were 17.1 ± 2.3%, 1.5 ± 0.7%, and 2.3 ± 0.9%, respectively. Other events included infection-related deaths during remission induction chemotherapy (3), primary refractory disease (2), and treatment-related deaths in first complete remission (8).
In this single-institution study of Korean pediatric ALL patients, risk group based intensification with omission of cranial irradiation resulted in EFS comparable to previous studies, excellent survival of low- and standard-risk patients, and a low rate of CNS relapse.
近期研究表明，小儿急性淋巴细胞白血病（ALL）的无事件生存率（EFS）为70 - 80%。在本研究中，我们报告了在我院接受治疗的295例儿童和青少年的治疗结果，将其分为四个风险组，且所有患者均未接受颅脑照射。
患者于2005年1月至2011年12月期间确诊，并分为低、中、高和极高风险组进行治疗。高风险和极高风险组接受了两次延迟强化治疗。所有患者均未接受颅脑照射以预防中枢神经系统（CNS）疾病。
10年EFS和总生存率（OS）分别为78.5±2.5%和81.9±2.7%。各风险组的EFS如下：低风险组91.2±3.7%，中风险组98.1±1.9%，高风险组81.5±4.3%，极高风险组59.4±5.3%。多因素分析显示，高超二倍体和婴儿ALL是EFS的显著预测因素。任何复发、孤立性CNS复发和任何CNS复发的累积发生率分别为17.1±2.3%、1.5±0.7%和2.3±0.9%。其他事件包括诱导缓解化疗期间与感染相关的死亡（3例）、原发性难治性疾病（2例）以及首次完全缓解期的治疗相关死亡（8例）。
在这项针对韩国小儿ALL患者的单中心研究中，基于风险组的强化治疗且未进行颅脑照射，其EFS与既往研究相当，低风险和中风险患者生存率高，CNS复发率低。
