Ceppi Francesco, Duval Michel, Leclerc Jean-Marie, Laverdiere Caroline, Delva Yves-Line, Cellot Sonia, Teira Pierre, Bittencourt Henrique
Hemato-Oncology Division, Charles Bruneau Cancer Research Center, CHU Ste-Justine, Department of Pediatrics, University of Montreal, Montreal, Quebec, Canada.
PLoS One. 2016 Sep 15;11(9):e0160310. doi: 10.1371/journal.pone.0160310. eCollection 2016.
Relapsed/refractory acute lymphoblastic leukemia (ALL) is a leading cause of death by cancer in children. Our institution has switched relapse treatment strategy to improve survival. We reviewed records of first relapse/refractory childhood ALL between 1996 and 2012. Based on length of first remission, relapse site and immunophenotype, patients were classified into two groups: standard-risk relapse (SRR) and high-risk relapse and refractory (HRRR). Before 2007, all patients were uniformly treated with the same induction as at presentation, followed by hematopoietic stem cell transplantation (HSCT). Since 2007, treatment was given according to risk of failure: SRR were mostly treated with chemotherapy; HRRR patients underwent HSCT after intensive chemotherapy, aiming reduction of pre-transplant disease burden. Sixty-four patients were included. Thirty (47%) were SRR and 34 (53%) HRRR, including 11 with refractory ALL. Five-years overall survival (OS) and event-free survival (EFS) were similar for SRR, but were significantly higher with new risk-based strategy for HRRR: 56% versus 17% (P = 0.03) for OS, and 56% vs 11% for EFS (P = 0.008), respectively. In multivariate analysis, treatment strategy was significantly associated with survival. In conclusion, change for a risk-based strategy in our institution increased survival of high-risk patients to levels similar of those of standard-risk patients.
复发/难治性急性淋巴细胞白血病（ALL）是儿童癌症死亡的主要原因。我们机构已改变复发治疗策略以提高生存率。我们回顾了1996年至2012年间首次复发/难治性儿童ALL的记录。根据首次缓解期的长短、复发部位和免疫表型，将患者分为两组：标准风险复发（SRR）和高风险复发及难治性（HRRR）。2007年之前，所有患者均接受与初诊时相同的诱导治疗，随后进行造血干细胞移植（HSCT）。自2007年起，根据失败风险进行治疗：SRR大多接受化疗；HRRR患者在强化化疗后接受HSCT，旨在减轻移植前的疾病负担。共纳入64例患者。30例（47%）为SRR，34例（53%）为HRRR，其中11例为难治性ALL。SRR的5年总生存率（OS）和无事件生存率（EFS）相似，但HRRR采用新的基于风险的策略时，这两项生存率显著更高：OS分别为56%和17%（P = 0.03），EFS分别为56%和11%（P = 0.008）。在多变量分析中，治疗策略与生存率显著相关。总之，我们机构采用基于风险的策略改变后，高风险患者的生存率提高到了与标准风险患者相似的水平。
