儿童急性淋巴细胞白血病化疗期间严重不良事件临床观察

目的 总结儿童急性淋巴细胞白血病患儿接受儿童急性淋巴细胞白血病治疗协作组2016方案(SCCLG-ALL-2016方案)治疗过程中严重不良事件(severe adverse events, SAE)的发生情况,并分析发生SAE后死亡的相关危险因素。方法 回顾性分析2017 年 12 月至 2021 年1月于广东医科大学附属医院儿科确诊并接受 SCCLG-ALL-2016 方案治疗的82 例急性淋巴细胞白血病患儿的临床特点,将化疗过程中发生SAE的患儿(n=21)分为死亡组(n=6)与存活组(n=15),分析化疗过程中发生SAE后导致死亡的相关危险因素。结果 在各治疗阶段中,以诱导缓解治疗阶段(30.9%)记录到的SAE数最多。血液学相关SAE(60.3%)是主要的SAE。在发生的非血液学相关不良事件中,感染相关SAE占比最大(76.1%),其中又以呼吸系统感染事件的发生次数最多。在死亡组的6名患儿中,5名患儿因感染或合并明确感染因素死亡,占死亡原因的83.3%。结论 SCCLG-ALL-2016方案治疗儿童急性淋巴细胞白血病过程中发生的SAE主要发生在诱导缓解治疗阶段,以血液学相关SAE为主;在非血液学相关不良事件中,感染相关SAE占比最高,同时也是化疗期间死亡的重要原因。染色体检查结果阳性可能与死亡结局相关。

Clinical observation of serious adverse events in children with acute lymphoblastic leukemia during chemotherapy

Objective To analyze the risk factors of severe adverse event(SAE)-related deaths in children with acute lymphoblastic leukemia (ALL) by summarizing the incidence of SAE during chemotherapy in patients receiving SCCLG-all-2016 regimen. Methods A retrospective analysis was performed on 82 ALL children admitted to the Department of Pediatrics of Affiliated Hospital of Guangdong Medical University, those children were treated with SCCLG-ALL-2016 regimen from December 2017 to January 2021, totally 21 children with SAE were assinged to death group (n=6) and survival group (n=15) to investigate the risk factors of SAE-related deaths during chemotherapy. Results Among the treatment stages, the largest number of SAEs was recorded in the stage of induction remission(30.9%). Hematology-related SAEs (60.3%) accounted for the majority of all SAEs. Among the non-hematology related SAEs, infection-related SAE accounted for the largest proportion (76.1%), and respiratory infection was the most frequent. Among the 6 children in the death group, 5 died of infection or co-infection factors, accounting for 83.3% of the causes of death. Conclusion For ALL children treated with SCCLG-ALL-2016 regimen, SAEs occurre mainly in the induced remission stage, mainly manifested as hematology-related SAE. Infection-related SAEs account for the highest proportion of non-hematology-related SAEs and are also important causes of death during chemotherapy. Positive chromosome results may be associated with death outcomes.