PDF(1271 KB)
两种不同方案治疗儿童急性淋巴细胞白血病骨髓复发的临床观察
赵贝贝, 陈晓娟, 郭晔, 杨文钰, 邹尧, 陈玉梅, 张丽, 阮敏, 刘晓明, 刘芳, 刘天峰, 戚本泉, 竺晓凡
中国当代儿科杂志 ›› 2020, Vol. 22 ›› Issue (4) : 346-349.
PDF(1271 KB)
PDF(1271 KB)
两种不同方案治疗儿童急性淋巴细胞白血病骨髓复发的临床观察
Clinical effect of two different regimens in treatment of acute lymphoblastic leukemia children with bone marrow recurrence
目的 回顾性分析两种不同再诱导方案治疗儿童急性淋巴细胞白血病（ALL）骨髓复发的短期疗效。方法 回顾性选择57例骨髓复发的ALL患儿为研究对象，根据治疗方案分为VMDP组（长春新碱+米托蒽醌+地塞米松+培门冬酰胺酶，n=42）和VIDP组（长春新碱+去甲氧柔红霉素+地塞米松+培门冬酰胺酶，n=15）。分析比较两组完全缓解率和不良反应发生率。结果 VMDP组和VIDP组完全缓解率（74% vs 73%）差异无统计学意义（P > 0.05）。所有患儿均发生3级或3级以上的血液学不良事件，VMDP组化疗相关病死率低于VIDP组（P < 0.05）。两组间感染发生率差异无统计学意义（P > 0.05）。结论 针对骨髓复发的儿童ALL，VMDP和VIDP再诱导方案均能获得较高的完全缓解率，且VMDP化疗方案引起的相关病死率更低，可作为儿童ALL骨髓复发再诱导方案的选择。
Objective To study the short-term effect of two different re-induction regimens in the treatment of acute lymphoblastic leukemia (ALL) children with bone marrow recurrence. Methods A retrospective analysis was performed for 57 ALL children with bone marrow recurrence. According to their treatment regimen, they were divided into two groups: VMDP (vincristine + mitoxantrone + dexamethasone + PEG-asparaginase; n=42) and VIDP (vincristine + idarubicin + dexamethasone + PEG-asparaginase; n=15). The two groups were compared in terms of complete response rate and incidence rate of adverse reactions. Results There was no significant difference in complete response rate between the VMDP and VIDP groups (74% vs 73%, P > 0.05). All children experienced grade ≥3 hematological adverse events. The VMDP group had a significantly lower chemotherapy-related mortality rate than the VIDP group (P < 0.05). There was no significant difference in the incidence rate of infection between the two groups (P > 0.05). Conclusions For ALL children with bone marrow recurrence, both re-induction regimens can achieve a relatively high complete response rate, and VMDP regimen has a lower chemotherapy-related mortality rate and can thus be used as an option for re-induction in ALL children with bone marrow recurrence.
Acute lymphoblastic leukemia / Marrow recurrence / Re-induction regimen / Child
[1] Zheng R, Peng X, Zeng H, et al. Incidence, mortality and survival of childhood cancer in China during 2000-2010 period:a population-based study[J]. Cancer Lett, 2015, 363(2):176-180.
[2] 陈晓平, 吕娜, 李永辉, 等. 44例青少年及年轻成人急性淋巴细胞白血病患者治疗的回顾性分析[J]. 中国实验血液学杂志, 2016, 24(1):14-18.
[3] Singh N, Frey NV, Grupp SA, et al. CAR T cell therapy in acute lymphoblastic leukemia and potential for chronic lymphocytic leukemia[J]. Curr Treat Options Oncol, 2016, 17(6):28.
[4] Hunger SP, Lu X, Devidas M, et al. Improved survival for children and adolescents with acute lymphoblastic leukemia between 1990 and 2005:a report from the Children's Oncology Group[J]. J Clin Oncol, 2012, 30(14):1663-1669.
[5] Pui CH. Recent advances in acute lymphoblastic leukemia[J]. Oncology (Williston Park), 2011, 25(4):341, 346-347.
[6] Schmiegelow K, Forestier E, Hellebostad M, et al. Long-term results of NOPHO ALI-92 and ALL-2000 studies of childhood acute lymphoblastic leukemia[J]. Leukemia, 2010, 24(2):345-354.
[7] Tallen G, Ratei R, Mann G, et al. Long-term outcome in children with relapsed acute lymphoblastic leukemia after time-point and site-of-relapse stratification and intensified short-course multidrug chemotherapy:results of trial ALL-REZ BFM 90[J]. J Clin Oncol, 2010, 28(14):2339-2347.
[8] 张之南, 沈悌. 血液病诊断及疗效标准[M]. 第3版. 北京:科学出版社, 2007:19-23.
[9] Parker C, Waters R, Leighton C, et al. Effect of mitoxantrone on outcome of children with first relapse of acute lymphoblastic leukaemia (ALL R3):an open-label randomised trial[J]. Lancet, 2010, 376(9757):2009-2017.
[10] 中华医学会儿科学分会血液学组, 《中华儿科杂志》编辑委员会. 儿童急性淋巴细胞白血病诊疗建议(第四次修订)[J]. 中华儿科杂志, 2014, 52(9):641-644.
[11] National Cancer Institute. Common Terminology Criteria for Adverse Events (CTCAE) v.4.0[DB/OL]. (2010-06-14)[2019-08-01]. https://ctep.cancer.gov/protocolDevelopment/electronic_applications/ctc.htm#ctc_40.
[12] Ghorashian S, Kramer AM, Onuoha S, et al. Enhanced CAR T cell expansion and prolonged persistence in pediatric patients with ALL treated with a low-affinity CD19 CAR[J]. Nat Med, 2019, 25(9):1408-1414.
[13] Camuset M, Grain A, Lorton F, et al. Use of blinatumomab in children acute lymphoblastic leukemia in the Grand Ouest interregion:a chance for all[J]. Bull Cancer, 2019, 106(3):206-215.
[14] Locatelli F, Testi AM, Bernardo ME, et al. Clofarabine, cyclphosphamide and etoposide as single-course re-induction therapy for children with refractory/multiple relapsed acute lymphoblastic leukaemia[J]. Br J Haematol, 2009, 147(3):371-378.
[15] Messinger Y, Gaynon P, Raetz E, et al. Phase I study of bortezomib combined with chemotherapy in children with relapsed childhood acute lymphoblastic leukemia (ALL):a report from the therapeutic advances in childhood leukemia (TACL) consortium[J]. Pediatr Blood Cancer, 2010, 55(2):254-259.
[16] Cooper TM, Razzouk BI, Gerbing R, et al. Phase I/II trial of clofarabine and cytarabine in children with relapsed/refractory acute lymphoblastic leukemia (AAML0523):a report from the Children's Oncology Group[J]. Pediatr Blood Cancer, 2013, 60(7):1141-1147.
[17] Sun W, Orgel E, Malvar J, et al. Treatment-related adverse events associated with a modified UK ALLR3 induction chemotherapy backbone for childhood relapsed/refractory acute lymphoblastic leukemia[J]. Pediatr Blood Cancer, 2016, 63(11):1943-1948.
[18] 范俊杰, 何海龙, 卢俊, 等. 中国儿童复发急性淋巴细胞白血病应用VDMP方案再诱导的安全性和有效性的评估-江苏小儿血液协作组报告[J]. 中国实验血液学杂志, 2018, 26(4):1033-1037.
[19] 邹尧, 张丽, 陈晓娟, 等. 大剂量甲强龙联合方案治疗复发或高危儿童急性淋巴细胞白血病的临床研究[J]. 白血病·淋巴瘤, 2007, 16(3):195-198.
