Long-term follow-up of relapsed childhood acute lymphoblastic leukaemia
Long-term follow-up of relapsed childhood acute lymphoblastic leukaemia
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DOI：
10.1046/j.1365-2141.2003.04584.x
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发表时间：
2003-11-01
影响因子：
6.5
通讯作者：
Hann, IM
中科院分区：
文献类型：
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作者：
Chessells, JM;Veys, P;Hann, IM
我们回顾了在一个单一的机构看到的505例急性淋巴细胞白血病（ALL）儿童复发后的结果。大多数复发（74%）发生在诊断后3年内，大多数仅涉及骨髓或伴有明显的髓外复发。早期复发在T-ALL和细胞遗传学不良的儿童中更常见。影响第二次缓解的因素包括首次缓解时间和复发类型。既往未接受过颅脑照射的儿童生存率上级。德国复发评分（包括首次缓解时间、复发部位和免疫表型）对结局具有高度预测性：接受现代治疗[强化化疗或骨髓移植（BMT）]的患者6年无事件生存率（95%置信区间）为标准风险的78%（51-92%），41%（33-49%）为中等风险，19%（10-31%）为最高风险。骨髓移植与化疗的回顾性比较显示，在中危组中没有差异，但在高危组中可能有优势。对235例化疗后复发并接受第三个疗程治疗的患者进行随访，发现早期脱落率极高，但少数患者在第三次缓解时存活。我们的结论是，需要新的方法来个性化治疗中危患者，并改善那些在最高风险组的结果。只有少数儿童在第三次缓解期能得到有效治疗。
We have reviewed the outcome after relapse in a cohort of 505 children with acute lymphoblastic leukaemia (ALL) seen at a single institution. The majority of relapses (74%) occurred within 3 years from diagnosis, and most involved the bone marrow alone or with overt extramedullary relapse. Early relapse was more common in children with T-ALL and those with unfavourable cytogenetics. Factors influencing second remission included length of first remission and type of relapse. Children who had not received previous cranial irradiation had a superior survival. The German relapse score involving length of first remission, site of relapse and immunophenotype was highly predictive of outcome: event-free survival with 95% confidence intervals at 6 years for patients who received modern treatment [intensive chemotherapy or bone marrow transplantation (BMT)] was 78% (51-92%) for standard risk, 41% (33-49%) for intermediate risk and 19% (10-31%) for highest risk. Retrospective comparison of BMT with chemotherapy showed no difference in the intermediate-risk group but a possible advantage in the highest risk group. Follow-up of 235 patients who relapsed after chemotherapy and received a third course of treatment showed an extremely high early attrition rate, but a small number of patients survived in third remission. We conclude that new approaches are needed to individualize therapy in intermediate-risk patients and to improve the outcome for those in the highest risk group. Only a small number of children can be treated effectively in third remission.