CCCG-ALL-2015方案治疗儿童急性淋巴细胞白血病复发的危险因素分析

doi:10.7499/j.issn.1008-8830.2401010

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摘要目的分析儿童急性淋巴细胞白血病（acute lymphoblastic leukemia, ALL）经中国儿童肿瘤协作组急性淋巴细胞白血病2015方案（Chinese Children's Cancer Group ALL-2015 protocol, CCCG-ALL-2015）治疗后的累积复发率（cumulative incidence of relapse, CIR），并探讨影响复发的危险因素。方法回顾性分析2015年1月—2019年12月接受CCCG-ALL-2015方案治疗的852例患儿的临床资料，计算CIR并分析影响儿童急性B淋巴细胞白血病（B-ALL）复发的危险因素。结果 852例ALL患儿中，146例（17.1%）发生复发，8年CIR为（19.8±1.6）%。B-ALL与急性T淋巴细胞白血病患儿的8年CIR比较差异无统计学意义（P>0.05）。146例复发患儿中，复发时间主要集中于极早期（62例，42.5%）和早期（46例，31.5%），极早期单纯骨髓复发42例（28.8%），早期单纯骨髓复发27例（18.5%）。Cox比例风险回归模型分析显示，融合基因MLLr阳性（HR=4.177，95%CI：2.086~8.364，P<0.001）和第46天微小残留病≥0.01%（HR=2.013，95%CI：1.163~3.483，P=0.012）是B-ALL患儿经CCCG-ALL-2015方案治疗后复发的危险因素。结论儿童ALL经CCCG-ALL-2015方案治疗后仍有较高的复发率，以极早期和早期单纯骨髓复发常见；第46天微小残留病≥0.01%、融合基因MLLr阳性与B-ALL复发密切相关。

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	陈霞
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关键词 ：急性淋巴细胞白血病, 中国儿童肿瘤协作组急性淋巴细胞白血病2015方案, 复发, 危险因素, 儿童

Abstract：Objective To investigate the cumulative incidence of recurrence (CIR) in children with acute lymphoblastic leukemia (ALL) after treatment with the Chinese Children's Cancer Group ALL-2015 (CCCG-ALL-2015) protocol and the risk factors for recurrence. Methods A retrospective analysis was conducted on the clinical data of 852 children who were treated with the CCCG-ALL-2015 protocol from January 2015 to December 2019. CIR was calculated, and the risk factors for the recurrence of B-lineage acute lymphoblastic leukemia (B-ALL) were analyzed. Results Among the 852 children with ALL, 146 (17.1%) experienced recurrence, with an 8-year CIR of 19.8%±1.6%. There was no significant difference in 8-year CIR between the B-ALL group and the acute T lymphocyte leukemia group (P>0.05). For the 146 children with recurrence, recurrence was mainly observed in the very early stage (n=62, 42.5%) and the early stage (n=46, 31.5%), and there were 42 children with bone marrow recurrence alone (28.8%) in the very early stage and 27 children with bone marrow recurrence alone (18.5%) in the early stage. The Cox proportional-hazards regression model analysis showed that positive MLLr fusion gene (HR=4.177, 95%CI: 2.086-8.364, P<0.001) and minimal residual disease≥0.01% on day 46 (HR=2.013, 95%CI: 1.163-3.483, P=0.012) were independent risk factors for recurrence in children with B-ALL after treatment with the CCCG-ALL-2015 protocol. Conclusions There is still a relatively high recurrence rate in children with ALL after treatment with the CCCG-ALL-2015 protocol, mainly bone marrow recurrence alone in the very early stage and the early stage, and minimal residual disease≥0.01% on day 46 and positive MLLr fusion gene are closely associated with the recurrence of B-ALL.

Key words： Acute lymphoblastic leukemia Chinese Children's Cancer Group ALL-2015 protocol Recurrence Risk factor Child

收稿日期: 2024-01-03

通讯作者: 于洁，女，主任医师，教授。Email：1808106657@qq.com。 E-mail: 1808106657@qq.com

作者简介: 陈霞，女，硕士研究生；

引用本文:

陈霞,雷小英,管贤敏等. CCCG-ALL-2015方案治疗儿童急性淋巴细胞白血病复发的危险因素分析[J]. 中国当代儿科杂志, 2024, 26(7): 701-707.

CHEN Xia,LEI Xiao-Ying,GUAN Xian-Min et al. Risk factors for recurrence of childhood acute lymphoblastic leukemia after treatment with the Chinese Children's Cancer Group ALL-2015 protocol[J]. CJCP, 2024, 26(7): 701-707.

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