SCMC-ALL-2005方案治疗儿童B细胞型急性淋巴细胞白血病疗效观察

摘要

目的：评估上海儿童医学中心-急性淋巴细胞性白血病-2005(SCMC-ALL-2005)治疗方案治疗儿童B细胞型ALL的疗效。方法按照SCMC-ALL-2005方案，5家医院对2005年5月1日至2009年4月30日新发B细胞型ALL患儿进行诊断、治疗和随访。结果研究期间共收治B细胞型ALL患儿601例，539例(89.68%)随访至2011年9月30日。601例患儿中，低危284例、中危231例、高危86例，均按照诊疗建议治疗。诱导期间缓解率为98.84%(7例未缓解)，第一次事件发生时的中位时间为35个月(2.94年)，至随访终止日的539例随访病例中共完成治疗403例(74.77%)；低危组完成治疗223例(86.43%)，中危组150例(73.17%)，高危组30例(39.47%)，三组间的差异有统计学意义(P=0.001)。采用Kaplan-Meier方法评估患儿随访3年的总生存率为(83.3±1.8)%，3年无事件生存(EFS)率为(79.2±1.9)%；随访5年总生存率为(79.5±3.3)%，5年EFS率为(70.9±3.7)%。低、中、高危三组间3年及5年EFS率差异有统计学意义(P均<0.05)。结论SCMC-ALL-2005方案治疗儿童B细胞型ALL的疗效比较满意，多中心协作有助于儿童白血病的规范化治疗。%Objective To analyze the outcome of childhood B-cell acute lymphoblastic leukemia treated (ALL) with SCMC-ALL-2005 protocol. Methods Newly diagnosed B-cell ALL from May 1, 2005 to April 30, 2009 in ifve hospitals were treated and followed up according to SCMC-ALL-2005 protocol. Results A total of 601 cases with newly diagnosed B-cell ALL were enrolled. Among them, 539 cases (89.68%) were followed up until September 30, 2011. In 601 patients, there were 284 low-risk cases (LR group), 231 moderate-risk cases (MR group) and 86 high-risk cases (HR group) which were treated with SCMC-ALL-2005 protocol. The total complete remission rate during the period of induction was 98.84%and 7 cases did not achieve complete remission. The median time of the ifrst event occurring was 35 months (2.94 years). Among 539 cases completing follow-up, 403 cases (74.77%) completed treatment including 223 cases (86.43%) in LR group, 150 cases (73.17%) in MR group and 30 cases (39.47%) in HR group. The rate of cases completing treatment was signiifcantly different among three groups (P=0.001). The completion rate was highest in LR group and lowest in HR group. The 3-year overall survival (OS) rate was (83.3±1.8)%, and the 3-year EFS (event-free survival) rate was (79.2±1.9)%using a Kaplan-Meier method. The 5-year OS rate was (79.5±3.3)%, and the 5-year EFS rate was (70.9±3.7)%. There were signiifcant differences in 3-year EFS rate and 5-year EFS rate among three groups (P<0.05). Conclusions Childhood B-ALL treated with SCMC-ALL-2005 protocol achieved a better therapeutic effect and prognosis. The multi-center collaborative research is useful for the standard treatment of ALL.