儿童急性淋巴细胞白血病复发后的生存情况：首次复发部位和时间的影响——儿童癌症研究组的经验
Survival after relapse in childhood acute lymphoblastic leukemia: impact of site and time to first relapse--the Children's Cancer Group Experience.
作者信息
Gaynon P S, Qu R P, Chappell R J, Willoughby M L, Tubergen D G, Steinherz P G, Trigg M E
机构信息
University of Wisconsin, Madison, USA.
出版信息
Cancer. 1998 Apr 1;82(7):1387-95. doi: 10.1002/(sici)1097-0142(19980401)82:7<1387::aid-cncr24>3.0.co;2-1.
BACKGROUND
Childhood acute lymphoblastic leukemia is the single most common childhood malignancy. Despite substantial improvements in therapy, cases in which relapse occurs are still more common than newly diagnosed cases of many other childhood cancers. The survival of patients who relapse despite improved therapy continues to be of interest.
METHODS
One thousand one hundred forty-four relapses and 28 second malignant neoplasms were identified among the 3712 eligible patients enrolled on Children's Cancer Group trials between 1983 and 1989. The details of treatment after relapse were not accessible. Subsequent secondary event free survival and overall survival were examined by the site of and time to initial relapse. A variety of potential prognostic factors were examined employing the log rank statistic and Wilcoxon regression model.
RESULTS
Rates of 6-year survival (+/- standard error) after isolated bone marrow, isolated central nervous system (CNS), and isolated testis relapse were 20%+/-2%, 48%+/-4%, and 70%+/-5%, respectively. Rates of survival after isolated bone marrow relapse at 0-17 months, 18-35 months, and after 36 months were 6%+/-2%, 11%+/-2%, and 43%+/-4%, respectively. Rates of survival after isolated CNS relapse at 0-17 months, 18-35 months, and after 36 months were 33%+/-4%, 59%+/-5%, and 72%+/-8%, respectively. Rates of survival after isolated testis relapse at 0-17 months, 18-35 months, and after 36 months were 52%+/-11%, 57%+/-10%, and 81%+/-5%, respectively. Rates of survival after combined bone marrow and CNS or testis relapse at 0-17 months, 18-35 months, and after 36 months were 9%+/-5%, 11%+/-6%, and 49%+/-7%, respectively.
CONCLUSIONS
Substantial survival at 6 years is evident among several subsets of this unselected group of heterogeneously treated children, namely, those with isolated or combined bone marrow relapse after 36 months and those with isolated extramedullary relapse at any time. Second malignant neoplasms are rare thus far.
背景
儿童急性淋巴细胞白血病是儿童期最常见的单一恶性肿瘤。尽管治疗有了显著改善，但复发病例仍比许多其他儿童癌症的新诊断病例更为常见。尽管治疗有所改进，但复发患者的生存情况仍然备受关注。
方法
在1983年至1989年参加儿童癌症集团试验的3712名符合条件的患者中，确定了1144例复发和28例第二原发性恶性肿瘤。复发后的治疗细节无法获取。通过首次复发的部位和时间来检查随后的无继发事件生存率和总生存率。采用对数秩统计和Wilcoxon回归模型检查了各种潜在的预后因素。
结果
孤立性骨髓复发、孤立性中枢神经系统（CNS）复发和孤立性睾丸复发后的6年生存率（±标准误差）分别为20%±2%、48%±4%和70%±5%。0至17个月、18至35个月以及36个月后孤立性骨髓复发后的生存率分别为6%±2%、11%±2%和43%±4%。0至17个月、18至35个月以及36个月后孤立性CNS复发后的生存率分别为33%±4%、59%±5%和72%±8%。0至17个月、18至35个月以及36个月后孤立性睾丸复发后的生存率分别为52%±11%、57%±10%和81%±5%。骨髓与CNS或睾丸联合复发后0至17个月、18至35个月以及36个月后的生存率分别为9%±5%、11%±6%和49%±7%。
结论
在这群未经选择、接受异质性治疗的儿童的几个亚组中，6年生存率显著，即36个月后出现孤立性或联合性骨髓复发的儿童以及任何时候出现孤立性髓外复发的儿童。到目前为止，第二原发性恶性肿瘤很少见。
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