单中心儿童急性T淋巴细胞白血病的临床特征及预后分析

doi:10.7499/j.issn.1008-8830.2408039

摘要
图/表
参考文献(18)
相关文章 (15)
点击分布统计
下载分布统计

全文: PDF (588 KB) [HTML]
输出: BibTeX | EndNote (RIS) 背景资料

摘要目的分析急性T淋巴细胞白血病（T-acute lymphoblastic leukemia, T-ALL）的临床特征、疗效及预后因素。方法对2015年4月—2022年12月广州医科大学附属妇女儿童医疗中心使用中国儿童肿瘤协作组急性淋巴细胞白血病方案治疗的T-ALL患儿进行回顾性分析。结果共纳入80例患儿，中位年龄为7岁3个月，男∶女为6∶1，纵隔占位占20%（16/80），伴中枢神经系统白血病占4%（3/80），睾丸白血病1%（1/69）。常见融合基因为SIL/TAL1（22%，18/80），常见基因突变为NOCTH1（69%，37/54）。中位随访时间为52个月，5年总生存（overall survival, OS）率为87.3%±4.0%，5年无事件生存率为84.0%±4.3%。非中枢神经系统-1状态患儿5年OS率低于中枢神经系统-1组（66.7%±16.1% vs 90.3%±3.8%，P<0.05），第46天微小残留病≥0.01%组5年OS率低于<0.01%组（68.6%±13.5% vs 94.8%±3.0%，P<0.05）。结论采用中国儿童肿瘤协作组急性淋巴细胞白血病方案治疗儿童T-ALL疗效较好。非中枢神经系统-1状态、诱导治疗第46天微小残留病≥0.01%与患儿不良预后有关。

	服务

	把本文推荐给朋友
	加入我的书架
	加入引用管理器
	E-mail Alert
	RSS
	作者相关文章
	陈晓燕
	王嘉怡
	江华
	张伟娜

关键词 ：白血病, T淋巴细胞, 预后, 儿童

Abstract：Objective To study the clinical characteristics and prognosis of T-lineage acute lymphoblastic leukemia (T-ALL) and related prognostic factors. Methods A retrospective analysis was conducted on the children with T-ALL who were treated with the Chinese Children's Cancer Group Acute Lymphoblastic Leukemia (CCCG-ALL) regimen in Guangzhou Women and Children's Medical Center between April 2015 and December 2022. Results A total of 80 children were included, with a median age of 7 years and 3 months and a male/female ratio of 6:1. Among these children, the children with mediastinal mass accounted for 20% (16/80), those with central nervous system leukemia accounted for 4% (3/80), and those with testicular leukemia accounted for 1% (1/69). SIL/TAL1 was the most common fusion gene (22%, 18/80), and NOTCH1 was the most common mutation gene (69%, 37/54). The median follow-up time was 52 months, with a 5-year overall survival (OS) rate of 87.3%±4.0% and a 5-year event-free survival rate of 84.0%±4.3%. The non-central nervous system-1 group had a significantly lower 5-year OS rate than the central nervous system-1 group (66.7%±16.1% vs 90.3%±3.8%; P<0.05), and the group with minimal residual disease (MRD) ≥0.01% on day 46 of induction therapy had a significantly lower 5-year OS rate than the group with MRD <0.01% (68.6%±13.5% vs 94.8%±3.0%; P<0.05). Conclusions Children treated with the CCCG-ALL regimen tend to have a good treatment outcome. Non-central nervous system-1 status and MRD ≥0.01% on day 46 of induction therapy are associated with the poor prognosis in these children.

Key words： Leukemia T lymphocyte Prognosis Child

收稿日期: 2024-08-08

基金资助:广州市妇女儿童医疗中心临床博士启动科研基金项目（2021BS008）；广州市科技局一般项目（博士青年科技人员类）（2023A04J0606）；广州市科技局（登峰医院）基础研究项目（2023A03J0893）。

通讯作者: 张伟娜，女，主治医师。Email：zwn18@126.com。 E-mail: zwn18@126.com

作者简介: 陈晓燕，女，博士研究生，住院医师；

引用本文:

陈晓燕,王嘉怡,江华等. 单中心儿童急性T淋巴细胞白血病的临床特征及预后分析[J]. 中国当代儿科杂志, 2024, 26(12): 1308-1314.

CHEN Xiao-Yan,WANG Jia-Yi,JIANG Hua et al. Clinical characteristics and prognosis of children with T-lineage acute lymphoblastic leukemia: a single-center study[J]. CJCP, 2024, 26(12): 1308-1314.

链接本文:

http://www.zgddek.com/CN/10.7499/j.issn.1008-8830.2408039 或 http://www.zgddek.com/CN/Y2024/V26/I12/1308

	Winter SS, Dunsmore KP, Devidas M, et al. Improved survival for children and young adults with T-lineage acute lymphoblastic leukemia: results from the Children's Oncology Group AALL0434 methotrexate randomization[J]. J Clin Oncol, 2018, 36(29): 2926-2934. PMID: 30138085. PMCID: PMC6366301. DOI: 10.1200/JCO.2018.77.7250.
	Cordo' V, van der Zwet JCG, Canté-Barrett K, et al. T-cell acute lymphoblastic leukemia: a roadmap to targeted therapies[J]. Blood Cancer Discov, 2020, 2(1): 19-31. PMID: 34661151. PMCID: PMC8447273. DOI: 10.1158/2643-3230.BCD-20-0093.
	Yang W, Cai J, Shen S, et al. Pulse therapy with vincristine and dexamethasone for childhood acute lymphoblastic leukaemia (CCCG-ALL-2015): an open-label, multicentre, randomised, phase 3, non-inferiority trial[J]. Lancet Oncol, 2021, 22(9): 1322-1332. PMID: 34329606. PMCID: PMC8416799. DOI: 10.1016/S1470-2045(21)00328-4.
	Liu X, Zou Y, Zhang L, et al. A novel risk defining system for pediatric T-cell acute lymphoblastic leukemia from CCCG-ALL-2015 group[J]. Front Oncol, 2022, 12: 841179. PMID: 35296004. PMCID: PMC8920043. DOI: 10.3389/fonc.2022.841179.
	中国抗癌协会小儿肿瘤专业委员会急性淋巴细胞白血病2015多中心研究协作组. CCCG-ALL-2015方案多中心临床报告[J]. 中华儿科杂志, 2022, 60(10): 1002-1010. PMID: 36207846. DOI: 10.3760/cma.j.cn112140-20220719-00895.
	中国儿童白血病协作组. 中国儿童白血病协作组2018方案治疗儿童急性T淋巴细胞白血病的多中心中期结果总结[J]. 中华儿科杂志, 2023, 61(10): 874-880. PMID: 37803853. DOI: 10.3760/cma.j.cn112140-20230719-00014.
	Simonin M, Vasseur L, Lengliné E, et al. NGS-based stratification refines the risk stratification in T-ALL and identifies a very-high-risk subgroup of patients[J]. Blood, 2024, 144(15): 1570-1580. PMID: 38848537. DOI: 10.1182/blood.2023023754.
	8 张伟娜, 王鹏飞, 甘文婷, 等. 靶向捕获高深度测序及转录组测序在儿童急性B淋巴细胞白血病中的应用[J]. 白血病·淋巴瘤, 2023, 32(3): 147-152. DOI: 10.3760/cma.j.cn115356-20220413-00108.
	Cui L, Li ZG, Chai YH, et al. Outcome of children with newly diagnosed acute lymphoblastic leukemia treated with CCLG-ALL 2008: the first nation-wide prospective multicenter study in China[J]. Am J Hematol, 2018, 93(7): 913-920. PMID: 29675840. DOI: 10.1002/ajh.25124.
	Burns MA, Place AE, Stevenson KE, et al. Identification of prognostic factors in childhood T-cell acute lymphoblastic leukemia: results from DFCI ALL Consortium Protocols 05-001 and 11-001[J]. Pediatr Blood Cancer, 2021, 68(1): e28719. PMID: 33026184. PMCID: PMC8369809. DOI: 10.1002/pbc.28719.
	Hayashi RJ, Winter SS, Dunsmore KP, et al. Successful outcomes of newly diagnosed T lymphoblastic lymphoma: results from Children's Oncology Group AALL0434[J]. J Clin Oncol, 2020, 38(26): 3062-3070. PMID: 32552472. PMCID: PMC7479761. DOI: 10.1200/JCO.20.00531.
	Teachey DT, Devidas M, Wood BL, et al. Children's Oncology Group trial AALL1231: a phase III clinical trial testing bortezomib in newly diagnosed T-cell acute lymphoblastic leukemia and lymphoma[J]. J Clin Oncol, 2022, 40(19): 2106-2118. PMID: 35271306. PMCID: PMC9242409. DOI: 10.1200/JCO.21.02678.
	Xu J, Zhu HH. Targeted treatment of T-cell acute lymphoblastic leukemia: latest updates from the 2022 ASH Annual Meeting[J]. Exp Hematol Oncol, 2023, 12(1): 30. PMID: 36906578. PMCID: PMC10007722. DOI: 10.1186/s40164-023-00384-4.
	Pui CH, Pei D, Coustan-Smith E, et al. Clinical utility of sequential minimal residual disease measurements in the context of risk-based therapy in childhood acute lymphoblastic leukaemia: a prospective study[J]. Lancet Oncol, 2015, 16(4): 465-474. PMID: 25800893. PMCID: PMC4612585. DOI: 10.1016/S1470-2045(15)70082-3.
	Tembhare PR, Narula G, Khanka T, et al. Post-induction measurable residual disease using multicolor flow cytometry is strongly predictive of inferior clinical outcome in the real-life management of childhood T-cell acute lymphoblastic leukemia: a study of 256 patients[J]. Front Oncol, 2020, 10: 577. PMID: 32391267. PMCID: PMC7193086. DOI: 10.3389/fonc.2020.00577.
	Hayashi RJ, Hermiston ML, Wood BL, et al. MRD at the end of induction and EFS in T-cell lymphoblastic lymphoma: Children's Oncology Group trial AALL1231[J]. Blood, 2024, 143(20): 2053-2058. PMID: 38457359. PMCID: PMC11143515. DOI: 10.1182/blood.2023021184.
	Petit A, Trinquand A, Chevret S, et al. Oncogenetic mutations combined with MRD improve outcome prediction in pediatric T-cell acute lymphoblastic leukemia[J]. Blood, 2018, 131(3): 289-300. PMID: 29051182. DOI: 10.1182/blood-2017-04-778829.
	Gossai NP, Devidas M, Chen Z, et al. Central nervous system status is prognostic in T-cell acute lymphoblastic leukemia: a Children's Oncology Group report[J]. Blood, 2023, 141(15): 1802-1811. PMID: 36603187. PMCID: PMC10122105. DOI: 10.1182/blood.2022018653.