儿童4期神经母细胞瘤联合治疗的临床疗效观察

梁伟玲; 叶小帆; 钟共; 陈建军; 戴康临; 卓家良; 莫姝; 王博深; 李春雨; 蒋轩竹; 徐志渊; 周黎; 陈秀慧; 陈健良; 朱知梅; 李珮华; 陈志峰

doi:10.7499/j.issn.1008-8830.2203049

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中国当代儿科杂志 ›› 2022, Vol. 24 ›› Issue (7) : 759-764. DOI: 10.7499/j.issn.1008-8830.2203049

论著·临床研究

儿童4期神经母细胞瘤联合治疗的临床疗效观察

梁伟玲¹, 叶小帆², 钟共¹, 陈建军¹, 戴康临³, 卓家良^4,5, 莫姝¹, 王博深¹, 李春雨¹, 蒋轩竹¹, 徐志渊⁶, 周黎¹, 陈秀慧⁷, 陈健良¹, 朱知梅⁷, 李珮华^1,4,5, 陈志峰^1,4,5

作者信息 +

Clinical efficacy of combined therapy in children with stage 4 neuroblastoma

LIANG Wei-Ling, YE Xiao-Fan, ZHONG Gong, CHEN Jian-Jun, DAI Kang-Lin, CHEUK Ka Leung Daniel, MO Shu, WANG Bo-Shen, LI Chun-Yu, JIANG Xuan-Zhu, XU Zhi-Yuan, ZHOU Li, CHAN Irene, CHEN Jian-Liang, CHU Patrick., LEE Pui Wah Pamela, CHAN Chi Fung Godfrey

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摘要

目的观察4期神经母细胞瘤联合治疗的早期疗效，探讨提高生存率及改善生活质量的治疗方案。方法对2016年1月至2021年6月在香港大学深圳医院确诊的14例4期神经母细胞瘤患儿的临床资料、治疗及随访情况进行回顾性分析。结果 14例患儿中位发病年龄为3岁7.5个月。骨髓检查阳性9例，N-Myc基因扩增4例，神经元特异性烯醇化酶增高13例，尿香草扁桃酸增高7例。病理结果：分化型6例，未分化型1例，混合型1例，分化差型6例。N7方案化疗10例（含2例N7方案+三氧化二砷化疗患儿），Rapid COJEC方案化疗4例。手术13例；自体造血干细胞移植14例；放疗10例。Ch14.18/CHO免疫治疗8例，其中1例因在治疗过程中出现过敏性休克而停止免疫治疗；其余7例完成治疗，期间未观察到严重不良反应。完成免疫治疗患儿中1例复发后进行3次Lu177 Dotatate治疗，目前仍在化疗中。14例患儿中位随访时间为45个月。2年内复发4例，2年内总生存率100%；3年内复发4例，3年内无病存活7例。结论儿童4期神经母细胞瘤建议选择多学科联合方案治疗，使4期神经母细胞瘤患儿获得更好的生存及预后。

Abstract

Objective To study the early clinical efficacy of combined therapy of stage 4 neuroblastoma. Methods A retrospective analysis was performed on the medical data and follow-up data of 14 children with stage 4 neuroblastoma who were diagnosed in Hong Kong University-Shenzhen Hospital from January 2016 to June 2021. Results The median age of onset was 3 years and 7.5 months in these 14 children. Among these children, 9 had positive results of bone marrow biopsy, 4 had N-Myc gene amplification, 13 had an increase in neuron-specific enolase, and 7 had an increase in vanilmandelic acid in urine. Based on the results of pathological examination, differentiated type was observed in 6 children, undifferentiated type in one child, mixed type, in one child and poorly differentiated type in 6 children. Of all the children, 10 received chemotherapy with the N7 regimen (including 2 children receiving arsenic trioxide in addition) and 4 received chemotherapy with the Rapid COJEC regimen. Thirteen children underwent surgery, 14 received hematopoietic stem cell transplantation, and 10 received radiotherapy. A total of 8 children received Ch14.18/CHO immunotherapy, among whom 1 child discontinued due to anaphylactic shock during immunotherapy, and the other 7 children completed Ch14.18/CHO treatment without serious adverse events, among whom 1 child was treated with Lu177 Dotatate 3 times after recurrence and is still undergoing chemotherapy at present. The median follow-up time was 45 months for all the 14 children. Four children experienced recurrence within 2 years, and the 2-year overall survival rate was 100%; 4 children experienced recurrence within 3 years, and 7 achieved disease-free survival within 3 years. Conclusions Multidisciplinary combined therapy is recommended for children with stage 4 neuroblastoma and can help them achieve better survival and prognosis.

导出引用

梁伟玲, 叶小帆, 钟共, 陈建军, 戴康临, 卓家良, 莫姝, 王博深, 李春雨, 蒋轩竹, 徐志渊, 周黎, 陈秀慧, 陈健良, 朱知梅, 李珮华, 陈志峰. 儿童4期神经母细胞瘤联合治疗的临床疗效观察[J]. 中国当代儿科杂志. 2022, 24(7): 759-764 https://doi.org/10.7499/j.issn.1008-8830.2203049

LIANG Wei-Ling, YE Xiao-Fan, ZHONG Gong, CHEN Jian-Jun, DAI Kang-Lin, CHEUK Ka Leung Daniel, MO Shu, WANG Bo-Shen, LI Chun-Yu, JIANG Xuan-Zhu, XU Zhi-Yuan, ZHOU Li, CHAN Irene, CHEN Jian-Liang, CHU Patrick., LEE Pui Wah Pamela, CHAN Chi Fung Godfrey. Clinical efficacy of combined therapy in children with stage 4 neuroblastoma[J]. Chinese Journal of Contemporary Pediatrics. 2022, 24(7): 759-764 https://doi.org/10.7499/j.issn.1008-8830.2203049

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