Outcome of Patients Treated for Relapsed or Refractory Acute Lymphoblastic Leukemia: A Therapeutic Advances in Childhood Leukemia Consortium Study
Outcome of Patients Treated for Relapsed or Refractory Acute Lymphoblastic Leukemia: A Therapeutic Advances in Childhood Leukemia Consortium Study
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DOI：
10.1200/jco.2009.22.2950
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发表时间：
2010-02-01
影响因子：
45.3
通讯作者：
Loh, Mignon L.
中科院分区：
文献类型：
--
作者：
Ko, Richard H.;Ji, Lingyun;Loh, Mignon L.
尽管治疗方法不断改进，但仍有约20%的急性淋巴细胞白血病（ALL）患者复发，预后不佳。儿童白血病治疗进展（TACL）联盟旨在评估治疗耐药白血病儿童的新药。我们假设，在可比人群中未能改善基线完全缓解率的新型药物和联合用药不太可能有助于改善结局，应该放弃。我们试图定义的反应率和无病生存（DFS）率在TACL机构，这可以作为一个比较未来的study.Patients和MethodsWe进行了回顾性队列研究的复发性和难治性ALL患者治疗的TACL机构之间的1995年和2004年的患者。收集了关于初始和复发疾病特征、疾病反应和生存率的数据，并与已发表的报告进行比较。（平均值+/- SE）早期首次骨髓复发为83% +/- 4%，晚期首次骨髓复发为93% +/- 3%，第二次骨髓复发为44% +/- 5%，第三次骨髓复发率为27% ± 6%。CR2和CR 3的5年DFS率分别为27% +/-4%and15%+/-7%respectively.ConclusionWe一般确认40%CR率为第二次和随后的复发，但我们的缓解率为早期首次复发似乎优于文献报道（83%v约70%）。我们的数据可能允许有用的建模的预期缓解率的任何人群的患者谁经历复发。
PurposeDespite improvements in treatment, approximately 20% of patients with acute lymphoblastic leukemia (ALL) experience relapse and do poorly. The Therapeutic Advances in Childhood Leukemia (TACL) Consortium was assembled to assess novel drugs for children with resistant leukemia. We hypothesize that novel agents and combinations that fail to improve baseline complete remission rates in comparable populations are unlikely to contribute to better outcomes and should be abandoned. We sought to define response rates and disease-free survival (DFS) rates in patients treated at TACL institutions, which could serve as a comparator for future studies.Patients and MethodsWe performed a retrospective cohort review of patients with relapsed and refractory ALL previously treated at TACL institutions between the years of 1995 and 2004. Data regarding initial and relapsed disease characteristics, disease response, and survival were collected and compared with those of published reports.ResultsComplete remission (CR) rates (mean +/- SE) were 83% +/- 4% for early first marrow relapse, 93% +/- 3% for late first marrow relapse, 44% +/- 5% for second marrow relapse, and 27% +/- 6% for third marrow relapse. Five-year DFS rates in CR2 and CR3 were 27% +/- 4% and 15% +/- 7% respectively.ConclusionWe generally confirm a 40% CR rate for second and subsequent relapse, but our remission rate for early first relapse seems better than that reported in the literature (83% v approximately 70%). Our data may allow useful modeling of an expected remission rate for any population of patients who experience relapse.