SCMC APL-2010方案治疗44例儿童急性早幼粒细胞白血病的临床总结

王卓, 沈树红, 汤燕静, 薛惠良, 胡文婷, 潘慈, 汤静燕, 顾龙君, 陈静

中国当代儿科杂志 ›› 2019, Vol. 21 ›› Issue (11) : 1073-1078.

PDF(1246 KB)
HTML
PDF(1246 KB)
HTML
中国当代儿科杂志 ›› 2019, Vol. 21 ›› Issue (11) : 1073-1078. DOI: 10.7499/j.issn.1008-8830.2019.11.004
论著·临床研究

SCMC APL-2010方案治疗44例儿童急性早幼粒细胞白血病的临床总结

  • 王卓, 沈树红, 汤燕静, 薛惠良, 胡文婷, 潘慈, 汤静燕, 顾龙君, 陈静
作者信息 +

Clinical effect of the SCMC APL-2010 regimen in treatment of acute promyelocytic leukemia in children: an analysis of 44 cases

  • WANG Zhuo, SHEN Shu-Hong, TANG Yan-Jing, XUE Hui-Liang, HU Wen-Ting, PAN Ci, TANG Jing-Yan, GU Long-Jun, CHEN Jing
Author information +
文章历史 +

摘要

目的 评价SCMC APL-2010方案治疗儿童急性早幼粒细胞白血病(APL)的疗效。方法 收集2010年4月至2016年7月采用SCMC APL-2010方案治疗的44例APL患儿的临床资料,采用Kaplan-Meier生存分析评估患儿的无事件生存(EFS)率和总生存(OS)率。结果 44例APL患儿中,42例(95%)经1个疗程达完全缓解(CR),1例经2个疗程达CR,总CR率为98%,9年EFS率为96%±3%,OS率为97.7%±2.2%。不良事件中,发生感染41例(93%),粒细胞减少29例(66%),分化综合征12例(27%,其中死亡1例),肝功能异常16例(36%),胃肠道不良反应12例(27%),QT间期延长7例(16%),睾丸炎1例(2%),无第二肿瘤发生。结论 SCMC APL-2010方案治疗儿童APL预后好,可获得长期生存,但治疗相关感染较多。

Abstract

Objective To study the clinical effect of the SCMC APL-2010 regimen in the treatment of acute promyelocytic leukemia (APL) in children. Methods A retrospective analysis was performed for the clinical data of 44 children with APL who received treatment with the SCMC APL-2010 regimen between April 2010 and July 2016. The Kaplan-Meier survival analysis was used to evaluate event-free survival (EFS) rate and overall survival (OS) rate. Results Of the 44 children with APL, 42 (95%) achieved a complete remission (CR) after one course of treatment and 1 achieved CR after two courses of treatment, with an overall CR rate of 98%. The 9-year EFS and OS rates were 96%±3% and 97.7%±2.2% respectively. As for adverse events, 41 (93%) had infection, 29 (66%) had granulocyte reduction, 12 (27%, 1 died) had differentiation syndrome, 16 (36%) had liver dysfunction, 12 (27%) had adverse gastrointestinal reactions, and 7 (16%) had QT prolongation, 1 (2%) had orchitis, and no secondary neoplasm was observed. Conclusions Children with APL receiving the SCMC APL-2010 regimen have a good prognosis and can achieve a long-term survival, while treatment-related infection is commonly seen.

关键词

急性早幼粒细胞白血病 / SCMC APL-2010方案 / 生存率 / 儿童

Key words

Acute promyelocytic leukemia / SCMC APL-2010 regimen / Survival rate / Child

引用本文

导出引用
王卓, 沈树红, 汤燕静, 薛惠良, 胡文婷, 潘慈, 汤静燕, 顾龙君, 陈静. SCMC APL-2010方案治疗44例儿童急性早幼粒细胞白血病的临床总结[J]. 中国当代儿科杂志. 2019, 21(11): 1073-1078 https://doi.org/10.7499/j.issn.1008-8830.2019.11.004
WANG Zhuo, SHEN Shu-Hong, TANG Yan-Jing, XUE Hui-Liang, HU Wen-Ting, PAN Ci, TANG Jing-Yan, GU Long-Jun, CHEN Jing. Clinical effect of the SCMC APL-2010 regimen in treatment of acute promyelocytic leukemia in children: an analysis of 44 cases[J]. Chinese Journal of Contemporary Pediatrics. 2019, 21(11): 1073-1078 https://doi.org/10.7499/j.issn.1008-8830.2019.11.004

参考文献

[1] Testi AM, Pession A, Diverio D, et al. Risk-adapted treatment of acute promyelocytic leukemia:results from the International Consortium for Childhood APL[J]. Blood, 2018, 132(4):405-412.
[2] Zhao H, Zhao Y, Zhang Y, et al. Difference in causes and prognostic factors of early death between cohorts with de novo and replapsed acute promyelocytic leukemia[J]. Ann Hematol, 2018, 97(3):409-416.
[3] Tao S, Wang C, Chen Y, et al. Long-term effect of all-trans retinoic acid and arsenic trioxide sequential maintenance in patients with acute promyelocytic leukemia[J]. Leuk Lymphoma, 2019, 60(3):711-719.
[4] Lo-Coco F, Cicconi L. What is the standard regimen for patients with acute promyelocytic leukemia?[J]. Curr Hematol Malig Rep, 2014, 9(2):138-143.
[5] 中华医学会血液学分会, 中国医师协会血液科医师分会. 中国急性早幼粒细胞白血病诊疗指南(2014年版)[J]. 中华血液学杂志, 2014, 35(5):475-477.
[6] Dueck AC, Mendoza TR, Mitchell SA, et al. Validity and reliability of the US National Cancer Institute's patient-reported outcomes version of the Common Terminology Criteria for Adverse Events (PRO-CTCAE)[J]. JAMA Oncol, 2015, 1(8):1051-1059.
[7] Adès L, Guerci A, Raffoux E, et al. Very long-term outcome of acute promyelocytic leukemia after treatment with all-trans retinoic acid and chemotherapy:the European APL Group experience[J]. Blood, 2010, 115(9):1690-1696.
[8] Quezada G, Kopp L, Estey E, et al. All-trans-retinoic acid and arsenic trioxide as initial therapy for acute promyelocytic leukemia[J]. Pediatr Blood Cancer, 2008, 51(1):133-135.
[9] Liu CC, Wang H, Wang WD, et al. Consolidation therapy of arsenic trioxide alternated with chemotherapy achieves remarkable efficacy in newly diagnosed acute promyelocytic leukemia[J]. Onco Targets Ther, 2015, 8:3297-3303.
[10] Dos Santos GA, Kats L, Pandolfi PP. Synergy against PMLRARa:targeting transcription, proteolysis, differentiation, and self-renewal in acute promyelocytic leukemia[J]. J Exp Med, 2013, 210(13):2793-2802.
[11] Masciarelli S, Capuano E, Ottone T, et al. Retinoic acid and arsenic trioxide sensitize acute promyelocytic leukemia cells to ER stress[J]. Leukemia, 2018, 32(2):285-294.
[12] Bapna A, Nair R, Tapan KS, et al. All-trans-retinoic acid (ATRA):pediatric acute promyelocytic leukemia[J]. Pediatr Hematol Oncol, 1998, 15(3):243-248.
[13] 陈静, 顾龙君, 汤静燕, 等. AML-XH-99-M3方案治疗33例儿童急性早幼粒细胞白血病临床总结[J]. 中国当代儿科杂志, 2008, 10(3):329-332.
[14] Kogan SC. Curing APL:differentiation or destruction?[J]. Cancer Cell, 2009, 15(1):7-8.
[15] Cheng Y, Zhang L, Wu J, et al. Long-term prognosis of childhood acute promyelocytic leukaemia with arsenic trioxide administration in induction and consolidation chemotherapy phases:a single-centre experience[J]. Eur J Haematol, 2013, 91(6):483-489.
[16] Esteve J, Escoda L, Martín G, et al. Outcome of patients with acute promyelocytic leukemia failing to front-line treatment with all-trans retinoic acid and anthracycline-based chemotherapy (PETHEMA protocols LPA96 and LPA99):benefit of an early intervention[J]. Leukemia, 2007, 21(3):446-452.
[17] Liu Y, Wang Z, Jiang M, et al. The expression of annexin II and its role in the fibrinolytic activity in acute promyelocytic leukemia[J]. Leuk Res, 2011, 35(7):879-884.
[18] Xin L, Wan-jun S, Zeng-jun L, et al. A survival study and prognostic factors analysis on acute promyelocytic leukemia at a single center[J]. Leuk Res, 2007, 31(6):765-771.
[19] Liang B, Zheng Z, Shi Y, et al. Maintenance therapy with alltrans retinoic acid and arsenic trioxide improves relapsefree survival in adults with low-to intermediate-risk acute promyelocytic leukemia who have achieved complete remission after consolidation therapy[J]. Onco Targets Ther, 2017, 10:2305-2313.

基金

浦东新区科技发展基金民生科研专项资金医疗卫生项目(PKJ2016-Y36);国家自然科学基金(81200374)。


PDF(1246 KB)
HTML

Accesses

Citation

Detail

段落导航
相关文章

/