Jaime-Pérez José Carlos, Pinzón-Uresti Mónica Andrea, Jiménez-Castillo Raúl Alberto, Colunga-Pedraza Julia Esther, González-Llano Óscar, Gómez-Almaguer David
a Department of Hematology , Dr. José Eleuterio González University Hospital of the School of Medicine, Universidad Autónoma de Nuevo León , Monterrey , Mexico.
Hematology. 2018 Jan;23(1):1-9. doi: 10.1080/10245332.2017.1333294. Epub 2017 Jun 3.
Relapse is the major cause of treatment failure in acute lymphoblastic leukemia (ALL) of childhood; it is more frequent among high-risk patients from low-middle income than from high-income countries. The frequency, sites and outcome of relapsed ALL in children of northeast Mexico over a decade was documented.
A retrospective analysis of 246 children belonging to a low-income group <16 years with de novo ALL during 2004-2015 was performed. Five-year overall survival (OS) and event-free survival was estimated by Kaplan-Meier analysis. Data on time, site, response to therapy and final outcome of relapse were analyzed. Hazard ratios (HRs) of relapse and death were estimated by the Cox regression model. Very early relapse was defined as that occurring in <18 months, early relapse between 18 and 36 months, and late relapse >36 months from diagnosis, respectively.
Eighty-seven (35.4%) children relapsed. Five-year OS was 82.6% in children without relapse vs. 42% for relapsed patients. Bone marrow (BM) was the most frequent site of relapse (51.72%). Isolated central nervous system (CNS) relapses occurred in 29.9%. Five-year OS was 11.2% for BM and 15.5% for early relapse. HR of relapse for organomegaly was 3.683, 2.247 for an initial white blood cell count >50 000 × 10/l and 1.169 for positive minimal residual disease status.
A high rate of very early, CNS, and BM relapse with a considerably low 5-year OS requiring reassessment of therapy was documented. Organomegaly at diagnosis was a highly significant clinical predictor for relapse.
复发是儿童急性淋巴细胞白血病（ALL）治疗失败的主要原因；在中低收入国家的高危患者中，复发比高收入国家更为常见。记录了墨西哥东北部儿童ALL复发的频率、部位及转归情况。
对2004年至2015年期间246例年龄＜16岁的低收入初发ALL儿童进行回顾性分析。采用Kaplan-Meier分析估计5年总生存率（OS）和无事件生存率。分析复发时间、部位、对治疗的反应及最终转归的数据。采用Cox回归模型估计复发和死亡的风险比（HRs）。极早期复发定义为诊断后＜18个月出现的复发，早期复发为诊断后18至36个月出现的复发，晚期复发为诊断后＞36个月出现的复发。
87例（35.4%）儿童复发。未复发儿童的5年OS为82.6%，复发患者为42%。骨髓（BM）是最常见的复发部位（51.72%）。孤立性中枢神经系统（CNS）复发占29.9%。BM复发的5年OS为11.2%，早期复发为15.5%。器官肿大的复发HR为3.683，初始白细胞计数＞50 000×10⁹/L的复发HR为2.247，微小残留病状态阳性的复发HR为1.169。
记录显示极早期、CNS和BM复发率高，5年OS相当低，需要重新评估治疗方案。诊断时器官肿大是复发的高度显著临床预测因素。
