Monsereenusorn Chalinee, Techavichit Piti, Sathitsamitphong Lalita, Lertvivatpong Nawachai, Winaichatsak Angkana, Chainansamit Su-On, Buaboonnam Jassada, Kuwatjanakul Pitchayanan, Chotsampancharoen Thirachit, Wangkittikal Chonthida, Kanchanakamhaeng Kittima, Suwannaying Kunanya, Sripattanatadasakul Pariwan, Wongruangsri Siranee, Phalakornkul Nattaporntira, Lertkovit Oranooj, Sinlapamongkolkul Phakatip, Songkhla Pokpong Na, Prasertphol Kerati, Pakakasama Samart
Division of Hematology-Oncology, Department of Pediatrics, Phramongkutklao Hospital and Phramongkutklao College of Medicine, Bangkok, Thailand.
Integrative and Innovative Hematology/Oncology Research Unit, Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.
Ann Hematol. 2024 Dec;103(12):5461-5472. doi: 10.1007/s00277-024-06068-1. Epub 2024 Nov 5.
The Thai Pediatric Oncology Group (ThaiPOG) has adapted treatment regimens from the Children's Oncology Group (COG) to enhance outcomes for childhood acute lymphoblastic leukemia (ALL). This study examined the risk factors and treatment results of pediatric ALL in Thailand. This multicenter study included newly diagnosed children (< 18 years) with ALL in 19 centers between January 1, 2015, and December 31, 2019. Most of the 1,157 patients (97.6%) were treated according to ThaiPOG protocols. The genetic testing was performed in 71% of patients. The patients were classified as standard (n = 539), high (n = 402), and very high (n = 130) risks. The 5-year event-free survival (EFS) and overall survival (OS) rates were 75% (95% confidence intervals (CI), 72%-77.8%) and 81.7% (95% CI, 78.9%-84.1%), respectively. The 5-year EFS rates of the standard-, high-, and very high-risk groups were 78.5% (95% CI, 74.1%-82.3%), 73.6% (95% CI, 68.5%-78%) (p = 0.761), and 65% (95% CI, 55.1%-73.3%) (p = 0.001), respectively, and the 5-year OS rates were 86.9% (95% CI, 83.1%-89.9%), 77.3% (95% CI, 72.5%-81.4%) (p = 0.001), and 73.1% (95% CI, 63.7%-80.4%) (p = 0.001), respectively. The independent risk factors for relapse and death were age ≥ 10 years, white blood cells (WBCs) ≥ 50,000/mm, M2 or M3 marrow status at the end of induction, and high-risk group. The overall outcome of Thai pediatric ALL has improved after the implementation of new modified COG treatment protocols. High-risk characteristics of ALL increased adverse outcome risk.
泰国儿科肿瘤学组（ThaiPOG）采用了儿童肿瘤学组（COG）的治疗方案，以提高儿童急性淋巴细胞白血病（ALL）的治疗效果。本研究调查了泰国儿童ALL的危险因素及治疗结果。这项多中心研究纳入了2015年1月1日至2019年12月31日期间在19个中心新诊断的18岁以下ALL患儿。1157例患者中的大多数（97.6%）按照ThaiPOG方案接受治疗。71%的患者进行了基因检测。患者被分为标准风险（n = 539）、高风险（n = 402）和极高风险（n = 130）组。5年无事件生存率（EFS）和总生存率（OS）分别为75%（95%置信区间（CI），72% - 77.8%）和81.7%（95% CI，78.9% - 84.1%）。标准风险、高风险和极高风险组的5年EFS率分别为78.5%（95% CI，74.1% - 82.3%）、73.6%（95% CI，68.5% - 78%）（p = 0.761）和65%（95% CI，55.1% - 73.3%）（p = 0.001），5年OS率分别为86.9%（95% CI，83.1% - 89.9%）、77.3%（95% CI，72.5% - 81.4%）（p = 0.001）和73.1%（95% CI，63.7% - 80.4%）（p = 0.001）。复发和死亡的独立危险因素为年龄≥10岁、白细胞（WBC）≥50,000/mm、诱导结束时M2或M3骨髓状态以及高风险组。实施新的改良COG治疗方案后，泰国儿童ALL的总体治疗效果有所改善。ALL的高风险特征增加了不良结局风险。
