Dujua Amanda Christina C, Hernandez Flerida G
Pediatric Hematology-Oncology, University of Santo Tomas Hospital, Manggahan, Pasig, Philippines.
J Pediatr Hematol Oncol. 2017 Apr;39(3):e116-e123. doi: 10.1097/MPH.0000000000000751.
This retrospective cohort study is primarily aimed to evaluate the outcome of children ages 0 to 18 years old, with acute lymphoblastic leukemia and treated with a modified Berlin-Frankfurt-Muenster/Hong Kong Acute Lymphoblastic Leukemia (BFM95-HKALL97) protocol at University of Santo Tomas Hospital from January 2005 to December 2009. Seventy-eight patients were included. Majority were between 1 and 10 years old (87.2%), male (61.5%), with normal nutritional status, and classified as upper socioeconomic class (65.3%), mainly from National Capital Region (24.3%). Eighty percent had mild anemia and a white cell count <50,000/mm. No patient had an initial platelet count <20,000/mm. More than 90% were standard risk, with FAB L1 morphology and pre-B immunophenotype. Five-year overall survival (OS) and event-free survival (EFS) rates were 86.94% and 86.2%, respectively. Among the 69 patients in the efficacy subset analysis, the 5-year OS and EFS rates were 98.36% and 86.80%, respectively. Relapse rate was 14.5%. Only FAB morphology and risk classification were correlated with relapse. Most common complications were febrile neutropenia, sepsis, and oral mucositis during induction phase. No deaths occurred due to treatment complications. In conclusion, using higher doses of methotrexate during consolidation phase improved the 5-year OS and EFS rates of our patients, without an increase in complications or deaths. Other contributing factors include improved adherence to treatment and risk-based treatment classification.
这项回顾性队列研究主要旨在评估2005年1月至2009年12月在圣托马斯大学医院接受改良柏林-法兰克福-明斯特/香港急性淋巴细胞白血病（BFM95-HKALL97）方案治疗的0至18岁急性淋巴细胞白血病患儿的治疗结果。共纳入78例患者。大多数患者年龄在1至10岁之间（87.2%），为男性（61.5%），营养状况正常，属于社会经济上层阶级（65.3%），主要来自国家首都地区（24.3%）。80%的患者有轻度贫血，白细胞计数<50,000/mm。没有患者初始血小板计数<20,000/mm。超过90%为标准风险，具有FAB L1形态和前B免疫表型。5年总生存率（OS）和无事件生存率（EFS）分别为86.94%和86.2%。在疗效亚组分析的69例患者中，5年OS和EFS率分别为98.36%和86.80%。复发率为14.5%。只有FAB形态和风险分类与复发相关。诱导期最常见的并发症是发热性中性粒细胞减少、败血症和口腔黏膜炎。没有因治疗并发症导致死亡。总之，在巩固期使用更高剂量的甲氨蝶呤提高了我们患者的5年OS和EFS率，且未增加并发症或死亡。其他促成因素包括治疗依从性的提高和基于风险的治疗分类。
