儿童急性淋巴细胞性白血病ALL-2005方案治疗失败病例分析

目的分析ALL-2005方案治疗儿童急性淋巴细胞性白血病(ALL)失败的原因。方法将初治ALL失败病例分为诱导治疗失败、复发和依从失败以及治疗相关死亡三类,回顾性分析失败的原因。结果 2005年5月1日至2009年4月30日,共388例初治ALL患儿,随访时间中位数48个月(24～72个月)。101例患儿治疗失败,总失败率为26.0%;其中诱导治疗失败6例,复发69例,依从失败17例,治疗相关死亡9例。骨髓复发率为13.2%,单纯中枢神经系统复发率为2.4%,男性患儿睾丸复发率为3.9%。388例ALL患儿中,300例B系ALL患儿在诱导治疗第35天监测微小残留病(MRD),MRD≤0.01%患儿的复发率为15.4%,而MRD>0.01%患儿为28.8%,两者间差异有统计学意义(χ2=5.818,P=0.016)。结论复发是导致ALL-2005方案治疗ALL失败的主要原因,诱导治疗第35天MRD水平可以预测患儿的预后。

Failure cases of pediatric acute lymphoblastic leukemia treated with protocol ALL-2005

Objective To analyze main reasons of the failure cases treated by protocol ALL-2005.Methods The failure patients treated initially by protocol ALL-2005 were identified into three categories: induction treatment failure,relapse and protocol compliance failure,and treatment related death.The main reasons of relapse,compliance failure and related death were analyzed retrospectively.Results A total of 388 ALL children from May 1st,2005 to April 30th,2009 were enrolled.The median follow-up time was 48 months(24-72 months),101 children failed the treatment and the total failure rate was 26.0%.Among the failure cases,6 were induction failure,69 were relapse,17 were protocol compliance failure and 9 were therapy related death.The relapse rate of bone marrow was 13.2%,the relapse rate of isolated central-nervous-system was 2.4% and the testicular relapse rate was 3.9%.On day 35,minimal residual disease(MRD) was detected in 300 B-ALL patients,the relapse rate was 15.4% for patients with MRD ≤ 0.01% however 28.8% for patients with MRD > 0.01%.The difference of treatment failure was significant between the two groups(χ2 = 5.818,P = 0.016).Conclusions Relapse was the main reason for treatment failure by protocol ALL 2005.The level of MRD on day 35 during induction treatment can predict patients’ prognosis.