Outcome After Relapse in Childhood Acute Lymphoblastic Leukemia
Outcome After Relapse in Childhood Acute Lymphoblastic Leukemia
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儿童急性淋巴细胞白血病复发后的结果
DOI：
10.1007/bf02982720
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发表时间：
2002
影响因子：
2.1
通讯作者：
K. Ueda
中科院分区：
文献类型：
--
作者：
K. Yumura‐Yagi;J. Hara;K. Horibe;A. Tawa;Y. Komada;M. Oda;S. Nishimura;Makoto Yoshida;T. Kudo;K. Ueda
本文分析了日本儿童白血病协会54个研究机构的157例急性淋巴细胞白血病(ALL)患儿复发后的转归，其中骨髓复发103例，中枢神经系统复发30例。BM复发组和CNS复发组复发率分别为72.3%和83.3%。在两组复发组和晚期(发病超过24个月)的BM复发患者中，B-前体(B-Pre)表型的再诱导率都很高。骨髓复发后，异基因干细胞移植(SCT)组总的5年生存率高于非SCT组(41.9%±8.2%比13.6%±6.5%，P<；0.0001)。在CNS复发后，SCT(异体+自体)组和非SCT组的4年总生存率分别为26.8%±14.2%和61.9%±12.3%，差异无统计学意义(P=.252)。晚期骨髓复发患者的存活率明显高于早期复发患者，在第二次完全缓解期间接受SCT时，异基因移植组和自体移植组的存活率相似。此外，根据美国国家癌症研究所/罗马标准在发病时被归入标准风险组的B-Pre所有患者在接受同种异体SCT后预后良好。要提高复发ALL患者的治愈率，需要进行更密集的再诱导治疗，并努力在BM复发的早期患者中成功进行SCT，以及建立包括CNS复发患者SCT适应证的治疗策略。
Among 157 children with acute lymphoblastic leukemia (ALL) who experienced relapse at 54 institutes participating in the Japan Association of Childhood Leukemia Study, we analyzed the outcomes after relapse in 103 and 30 eligible cases with bone marrow (BM) and central nervous system (CNS) relapse, respectively. Reinduction rates in BM and CNS relapse cases were 72.3% and 83.3%, respectively. High reinduction rates were observed in B-precursor (B-pre) phenotype ALL in both relapse groups and in late (more than 24 months from onset) BM-relapse patients. After BM relapse, the overall 5-year survival rate was superior in the allogeneic stem cell transplantation (SCT) group compared to the non-SCT group (41.9% ± 8.2% versus 13.6% ± 6.5%,P<.0001). In contrast, the 4-year overall survival rate was not significantly different between the SCT (allogeneic plus autologous) and non-SCT groups after CNS relapse (26.8% ± 14.2% versus 61.9% ± 12.3%,P =.252). The late BM-relapse patients showed a significantly higher survival rate than did early-relapse patients, and survival rates were similar between the allogeneic and autologous group when the patients underwent SCT during a second complete remission. Moreover, B-pre ALL patients classified in the standard-risk group according to National Cancer Institute/Rome’s criteria at onset had a good prognosis after allogeneic SCT. Improving the cure rate in relapsed ALL patients requires more intensive reinduction therapy and efforts to succeed with SCT in early BM-relapse patients as well as the establishment of a treatment strategy including indications of SCT for CNS-relapse patients.
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自体与无关供体同种异体骨髓移植治疗急性淋巴细胞白血病。
影响因子：
20.3
作者：
Weisdorf,DJ;Billett,AL;Hannan,P;Ritz,J;Sallan,SE;Steinbuch,M;Ramsay,NK
通讯作者：
Ramsay,NK
强化轮换联合化疗对儿童急性淋巴细胞白血病晚期血液学复发的有效性。
影响因子：
20.3
作者：
Rivera,GK;Hudson,MM;Liu,Q;Benaim,E;Ribeiro,RC;Crist,WM;Pui,CH
通讯作者：
Pui,CH
影响因子：
158.5
作者：
BARRETT, AJ;HOROWITZ, MM;GALE, RP
通讯作者：
GALE, RP
影响因子：
45.3
作者：
RIBEIRO, RC;RIVERA, GK;PUI, CH
通讯作者：
PUI, CH
影响因子：
45.3
作者：
Smith, M;Arthur, D;Ungerleider, R
通讯作者：
Ungerleider, R