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Liao C, Shen DY, Xu XJ, Xu WQ, Zhang JY, Song H, Yang SL, Zhao FY, Shen HP, Tang YM. [Long-term outcome of childhood T-cell acute lymphoblastic leukemia treated with modified national protocol of childhood leukemia in China-acute lymphoblastic leukemia 2008]. Zhonghua Er Ke Za Zhi 2020; 58:758-763. [PMID: 32872717 DOI: 10.3760/cma.j.cn12140-20200116-00035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Objective: To analyse the long-term efficacy in childhood T-cell acute lymphoblastic leukemia (T-ALL) cases enrolled in the national protocol of childhood leukemia in China-acute lymphoblastic leukemia (NPCLC-ALL) 2008. Methods: Clinical data of 96 patients diagnosed as T-ALL and treated with NPCLC-ALL2008 protocol between January 2009 and December 2017 in the Department of Hematology-Oncology, the Children's Hospital, Zhejiang University School of Medicine were analyzed retrospectively. Predictive value of minimal residual disease (MRD) monitored by flow cytometry was analyzed. Kaplan-Meier method was used for long-term survival analysis. Results: A total of 96 evaluable patients with newly diagnosed T-ALL were analysed, including 72 males and 24 females. The age was 9.5 (ranged from 1.0 to 16.0) years. The follow-up time was 5.7 (ranged from 1.0 to 9.7) years. Among 96 patients, 92 (96%) achieved complete remission. The 5-year event free survival (EFS) and overall survival (OS) rates were (61±6) % and (70±5) %, respectively. Relapse occurred in 18 cases and the 5-year cumulative incidence of relapse was (27±6) %. Twenty-four patients died. The 5-year OS rates of patients with MRD>5% on day 15 of induction therapy was significantly worse than those with MRD≤5% ((60±12) % vs. (72±6) %, χ(2)=3.904, P=0.048) . The 5-year EFS and OS rates were obviously lower in patients with MRD>10% before the consolidation therapy ((50±35) %). The 5-year OS rates of patients with relapsed disease was significantly worse than those without ((26±13) % vs. (81±5) %, χ(2)=18.411, P<0.01). The earlier the relapse, the worse the prognosis. The 5-year OS rates for patients relapsed within 6 months, within 3 years and more than 3 years, were (25±22) %, (30±14) % and (50±35) % respectively (χ(2)=13.207, P<0.01). Conclusions: NPCLC-ALL2008 protocol is effective for childhood T-ALL. The MRD guided accurate risk stratification and individualized treatment can reduce the relapse and improve the survival rate of pediatric T-ALL.
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Affiliation(s)
- C Liao
- Department of Hematology-Oncology, the Children's Hospital, Zhejiang University School of Medicine, Pediatric Leukemia Diagnostic and Therapeutic Technology Research Center of Zhejiang Province, National Clinical Research Center for Child Health, Hangzhou 310003, China
| | - D Y Shen
- Department of Hematology-Oncology, the Children's Hospital, Zhejiang University School of Medicine, Pediatric Leukemia Diagnostic and Therapeutic Technology Research Center of Zhejiang Province, National Clinical Research Center for Child Health, Hangzhou 310003, China
| | - X J Xu
- Department of Hematology-Oncology, the Children's Hospital, Zhejiang University School of Medicine, Pediatric Leukemia Diagnostic and Therapeutic Technology Research Center of Zhejiang Province, National Clinical Research Center for Child Health, Hangzhou 310003, China
| | - W Q Xu
- Department of Hematology-Oncology, the Children's Hospital, Zhejiang University School of Medicine, Pediatric Leukemia Diagnostic and Therapeutic Technology Research Center of Zhejiang Province, National Clinical Research Center for Child Health, Hangzhou 310003, China
| | - J Y Zhang
- Department of Hematology-Oncology, the Children's Hospital, Zhejiang University School of Medicine, Pediatric Leukemia Diagnostic and Therapeutic Technology Research Center of Zhejiang Province, National Clinical Research Center for Child Health, Hangzhou 310003, China
| | - H Song
- Department of Hematology-Oncology, the Children's Hospital, Zhejiang University School of Medicine, Pediatric Leukemia Diagnostic and Therapeutic Technology Research Center of Zhejiang Province, National Clinical Research Center for Child Health, Hangzhou 310003, China
| | - S L Yang
- Department of Hematology-Oncology, the Children's Hospital, Zhejiang University School of Medicine, Pediatric Leukemia Diagnostic and Therapeutic Technology Research Center of Zhejiang Province, National Clinical Research Center for Child Health, Hangzhou 310003, China
| | - F Y Zhao
- Department of Hematology-Oncology, the Children's Hospital, Zhejiang University School of Medicine, Pediatric Leukemia Diagnostic and Therapeutic Technology Research Center of Zhejiang Province, National Clinical Research Center for Child Health, Hangzhou 310003, China
| | - H P Shen
- Department of Hematology-Oncology, the Children's Hospital, Zhejiang University School of Medicine, Pediatric Leukemia Diagnostic and Therapeutic Technology Research Center of Zhejiang Province, National Clinical Research Center for Child Health, Hangzhou 310003, China
| | - Y M Tang
- Department of Hematology-Oncology, the Children's Hospital, Zhejiang University School of Medicine, Pediatric Leukemia Diagnostic and Therapeutic Technology Research Center of Zhejiang Province, National Clinical Research Center for Child Health, Hangzhou 310003, China
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Liao HY, Sun ZY, Wang YX, Jin YM, Zhu HL, Jiang NG. [Outcome of 126 adolescent and adult T-cell acute leukemia/lymphoma patients and the prognostic significance of early T-cell precursor leukemia subtype]. Zhonghua Xue Ye Xue Za Zhi 2020; 40:561-567. [PMID: 32397018 PMCID: PMC7364909 DOI: 10.3760/cma.j.issn.0253-2727.2019.07.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
目的 分析我国急性T淋巴细胞白血病/淋巴瘤(T-ALL/LBL)患者的临床特征,探究急性早期前体T淋巴细胞白血病/淋巴瘤(ETP-ALL/LBL)分型的预后意义。 方法 回顾性分析2008年1月至2014年12月间在四川大学华西医院就诊的126例T-ALL/LBL患者临床资料,基于白血病细胞的免疫表型将其分为三组:ETP-ALL/LBL(CD1a−,CD8−,CD5−/dim以及一种或多种干细胞和髓系相关抗原表达)、近似ETP-ALL/LBL(除CD5+外其他同ETP-ALL表型特征)及非ETP-ALL/LBL(non-ETP-ALL/LBL)组,对患者的实验室指标及预后相关因素进行分析。 结果 126例T-ALL/LBL患者中男女比例为2.5∶1,中位年龄为25(14~77)岁,ETP-ALL/LBL亚型的比例高达47.6%。T-ALL患者首次化疗完全缓解(CR1)率显著高于T-LBL患者(64.4%对30.8%,P=0.032);初诊外周血WBC>50×109/L的患者CR1率显著高于WBC ≤ 50×109/L的患者(78.4%对50.9%,P=0.010)。相较于non-ETP-ALL/LBL组,ETP-ALL/LBL组患者发病年龄更大(P<0.001)、外周血WBC更低(P<0.001)、病程中中枢神经系统浸润率更低(10.0%对30.2%,P=0.009)。ETP-ALL/LBL组患者CR1率显著低于non-ETP-ALL/LBL组(37.3%对84.6%,P<0.001);ETP-ALL/LBL组患者较non-ETP-ALL/LBL组患者总生存期短,但差异无统计学意义(P=0.073)。T系抗原CD1a+组、CD8+组、CD4+组的CR1率均比相应的阴性组高(P值分别为0.002、0.000、0.001),而髓系抗原CD33+组、CD56+组CR1率均比相应的阴性组低(P值分别为0.035、0.035)。 结论 中国青少年和成人T-ALL患者中ETP-ALL/LBL亚型比例高,ETP-ALL/LBL属于成人ALL的高危亚型,需要更精确的诊断及新的治疗策略来改善预后。
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Affiliation(s)
- H Y Liao
- Department of Laboratory Medicine, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Z Y Sun
- National Center for Clinical Laboratories, Beijing 100730, China
| | - Y X Wang
- Department of Laboratory Medicine, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Y M Jin
- Department of Laboratory Medicine, West China Hospital, Sichuan University, Chengdu 610041, China
| | - H L Zhu
- Department of Hematology, West China Hospital, Sichuan University, Chengdu 610041, China
| | - N G Jiang
- Department of Laboratory Medicine, West China Hospital, Sichuan University, Chengdu 610041, China
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