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[采用白血病治疗方案治疗儿童T淋巴细胞母细胞淋巴瘤的预后分析]

[Prognostic analysis of childhood T-lymphoblastic lymphoma treated with leukemia regimen].

作者信息

Hou Shu-Min, Shao Jing-Bo, Li Hong, Zhang Na, Zhu Jia-Shi, Wang Dan, Fu Pan

机构信息

Department of Hematology/Oncology, Shanghai Children's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200040, China.

出版信息

Zhongguo Dang Dai Er Ke Za Zhi. 2024 May 15;26(5):469-475. doi: 10.7499/j.issn.1008-8830.2311060.

Abstract

OBJECTIVES

To investigate the prognosis of childhood T-lymphoblastic lymphoma (T-LBL) treated with acute lymphoblastic leukemia (ALL) regimen and related influencing factors.

METHODS

A retrospective analysis was performed for the prognostic characteristics of 29 children with T-LBL who were treated with ALL regimen (ALL-2009 or CCCG-ALL-2015 regimen) from May 2010 to May 2022.

RESULTS

The 29 children with T-LBL had a 5-year overall survival (OS) rate of 84%±7% and an event-free survival (EFS) rate of 81%±8%. The children with B systemic symptoms (unexplained fever >38°C for more than 3 days; night sweats; weight loss >10% within 6 months) at initial diagnosis had a lower 5-year EFS rate compared to the children without B symptoms (<0.05). The children with platelet count >400×10/L and involvement of both mediastinum and lymph nodes at initial diagnosis had lower 5-year OS rates (<0.05). There were no significant differences in 5-year OS and EFS rates between the children treated with CCCG-ALL-2015 regimen and those treated with ALL-2009 regimen (>0.05). Compared with the ALL-2009 regimen, the CCCG-ALL-2015 regimen reduced the frequency of high-dose methotrexate chemotherapy and the incidence rate of severe infections (<0.05).

CONCLUSIONS

The ALL regimen is safe and effective in children with T-LBL. Children with B systemic symptoms, platelet count >400×10/L, and involvement of both mediastinum and lymph nodes at initial diagnosis tend to have a poor prognosis. Reduction in the frequency of high-dose methotrexate chemotherapy can reduce the incidence rate of severe infections, but it does not affect prognosis.

摘要

目的

探讨采用急性淋巴细胞白血病(ALL)方案治疗的儿童T淋巴细胞母细胞淋巴瘤(T-LBL)的预后及相关影响因素。

方法

对2010年5月至2022年5月采用ALL方案(ALL-2009或CCCG-ALL-2015方案)治疗的29例儿童T-LBL的预后特征进行回顾性分析。

结果

29例儿童T-LBL的5年总生存率(OS)为84%±7%,无事件生存率(EFS)为81%±8%。初诊时有B系统症状(不明原因发热>38℃超过3天;盗汗;6个月内体重减轻>10%)的儿童,其5年EFS率低于无B症状的儿童(<0.05)。初诊时血小板计数>400×10⁹/L且纵隔和淋巴结均受累的儿童,其5年OS率较低(<0.05)。采用CCCG-ALL-2015方案治疗的儿童与采用ALL-2009方案治疗的儿童,其5年OS率和EFS率无显著差异(>0.05)。与ALL-2009方案相比,CCCG-ALL-2015方案降低了大剂量甲氨蝶呤化疗的频率和严重感染的发生率(<0.05)。

结论

ALL方案治疗儿童T-LBL安全有效。初诊时有B系统症状、血小板计数>400×10⁹/L且纵隔和淋巴结均受累的儿童预后往往较差。降低大剂量甲氨蝶呤化疗的频率可降低严重感染的发生率,但不影响预后。

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