Childhood T-cell acute lymphoblastic leukemia: The Dana-Farber Cancer Institute acute lymphoblastic leukemia consortium experience
Childhood T-cell acute lymphoblastic leukemia: The Dana-Farber Cancer Institute acute lymphoblastic leukemia consortium experience
复制标题
DOI：
10.1200/jco.2003.10.116
复制
发表时间：
2003-10-01
影响因子：
45.3
通讯作者：
Asselin, BL
中科院分区：
文献类型：
--
作者：
Goldberg, JM;Silverman, LB;Asselin, BL
目的：T细胞急性淋巴细胞白血病（T-ALL）占儿童急性淋巴细胞白血病（ALL）初诊病例的10%~ 15%。从历史上看，T-ALL患者有一个更糟糕的预后比其他ALL patients.Patients和方法：我们回顾了125例T-ALL治疗丹娜-法伯癌症研究所（DFCI）ALL联盟试验1981年和1995年之间的结果。治疗包括4或5种药物诱导缓解;多柔比星、长春新碱、皮质类固醇、巯基嘌呤和每周一次大剂量天冬酰胺酶巩固治疗;以及颅部放疗。T-ALL患者的治疗与高危B祖细胞ALL患者相同。1981 ~ 2000年15例T淋巴母细胞性淋巴瘤患者也接受了同样的高危方案治疗。结果：T-ALL患者5年无事件生存率（EFS）为75% ± 4%。15例T细胞淋巴母细胞性淋巴瘤患者中有14例长期存活。T-ALL和B祖细胞ALL患者的EFS无显著差异（P = 0.56），尽管T-ALL患者诱导失败率（P <0.0001）和中枢神经系统（CNS）复发率（P = 0.02）显著较高。T-ALL患者的中位复发时间为1.2年，而B祖细胞ALL患者为2.5年（P = 0.001）。T-ALL患者的治疗前特征与预后不良无关。结论：DFCI ALL联盟方案中T-ALL患者与B祖细胞患者的治疗效果相同。T-ALL患者诱导失败、早期复发和孤立CNS复发的风险仍然增加。未来的研究应侧重于识别和治疗T-ALL患者的治疗失败的高风险。(C)2003年，美国临床肿瘤学会。
Purpose: T-cell acute lymphoblastic leukemia (T-ALL) accounts for 10% to 15% of newly diagnosed cases of childhood acute lymphoblastic leukemia (ALL). Historically, T-ALL patients have had a worse prognosis than other ALL patients.Patients and Methods: We reviewed the outcomes of 125 patients with T-ALL treated on Dana-Farber Cancer Institute (DFCI) ALL Consortium trials between 1981 and 1995. Therapy included four- or five-agent remission induction; consolidation therapy with doxorubicin, vincristine, corticosteroid, mercaptopurine, and weekly high-dose asparaginase; and cranial radiation. T-ALL patients were treated the same as high-risk B-progenitor ALL patients. Fifteen patients with T-cell lymphoblastic lymphoma were also treated with the same high-risk regimen between 1981 and 2000.Results: The 5-year event-free survival (EFS) rate for T-ALL patients was 75% +/- 4%. Fourteen of 15 patients with T-cell lymphoblastic lymphoma were long-term survivors. There was no significant difference in EFS comparing patients with T-ALL and B-progenitor ALL (P = .56), although T-ALL patients had significantly higher rates of induction failure (P < .0001), and central nervous system (CNS) relapse (P = .02). The median time to relapse in T-ALL patients was 1.2 years versus 2.5 years in B-progenitor ALL patients (P = .001). There were no pretreatment characteristics associated with worse prognosis in patients with T-ALL.Conclusion: T-ALL patients fared as well as B-progenitor patients on DFCI ALL Consortium protocols. Patients with T-ALL remain at increased risk for induction failure, early relapse, and isolated CNS relapse. Future studies should focus on the identification of and treatment for T-ALL patients at high risk for treatment failure. (C) 2003 by American Society of Clinical Oncology.