Que Li-Ping, Huang Ke, Fang Jian-Pei, Xu Hong-Gui, Zhou Dun-Hua, Li Yang, Xu Lv-Hong, Li Jian, Chen Hai-Lei
Department of Paediatrics, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, P.R. China.
J Pediatr Hematol Oncol. 2018 Aug;40(6):472-477. doi: 10.1097/MPH.0000000000001131.
To explore the clinical features and outcomes of relapsed childhood acute lymphoblastic leukemia (ALL) at our center, achieve the early detection of risk factors for recurrence and assess the risk-stratified Guangdong (GD)-2008 ALL protocol.
In total, 59 Chinese childhood ALL patients treated with the GD-2008 ALL protocol who relapsed between July 2008 and March 2015 were enrolled in this study. Their clinical features and outcomes were retrospectively analyzed and compared with those of 218 patients who achieved continuous complete remission.
Of the 285 study participants, 8 died of treatment-related infections or other complications before remission, 218 achieved continuous complete remission, and 59 patients relapsed, yielding a relapse rate of 20.7%. The number of relapsed patients in the standard-risk, intermediate-risk, and high-risk groups were 15 (17.0%), 27 (19.7%), and 17 (32.7%), respectively. Risk factors included age 10 years and above at first diagnosis, white blood cell (WBC) count ≥50×10/L, poor prednisone response, failure to achieve bone marrow complete remission at day 15 of induction chemotherapy. High-risk stratification and a high level (≥0.1%) of minimal residual disease at day 33 were the risk factors for relapse. Multivariate analysis showed that a high WBC at first diagnosis was an independent risk factor for relapse (P=0.000).
For the GD-2008 ALL risk stratification based on age and initial WBC, 10 years of age and WBC 50×10/L can be used as cut-offs. Patients at high risk benefited from the GD-2008 ALL protocol. In addition, the impact of minimal residual disease on prognosis should be considered.
探讨我院儿童复发性急性淋巴细胞白血病（ALL）的临床特征及转归，实现复发危险因素的早期发现，并评估风险分层的广东（GD）-2008 ALL方案。
本研究纳入了2008年7月至2015年3月期间采用GD-2008 ALL方案治疗后复发的59例中国儿童ALL患者。回顾性分析了他们的临床特征及转归，并与218例持续完全缓解的患者进行比较。
在285例研究参与者中，8例在缓解前死于治疗相关感染或其他并发症，218例实现持续完全缓解，59例患者复发，复发率为20.7%。标准风险组、中危组和高危组的复发患者数分别为15例（17.0%）、27例（19.7%）和17例（32.7%）。危险因素包括首次诊断时年龄≥10岁、白细胞（WBC）计数≥50×10⁹/L、泼尼松反应差、诱导化疗第15天时未达到骨髓完全缓解。高危分层及诱导化疗第33天时微小残留病水平≥0.1%是复发的危险因素。多因素分析显示首次诊断时高白细胞是复发的独立危险因素（P=0.000）。
对于基于年龄和初始白细胞的GD-2008 ALL风险分层，10岁及白细胞50×10⁹/L可作为界值。高危患者从GD-2008 ALL方案中获益。此外，应考虑微小残留病对预后的影响。
