First Relapse of Acute Lymphoblastic Leukemia in Children in Upper Egypt: Survival Outcome and Prognostic Factors

A. Shibl, H. Sayed, A. Zahran
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引用次数: 1

Abstract

Background: Relapse is the main reason of treatment failure in childhood acute Lymphoblastic leukemia (ALL). Aim: To study the treatment outcome of first ALL relapse in response to two different reinduction regimens and prognostic factors predicting outcome. Methods: A retrospective study that included 82 children with ALL in the 1st relapse from two tertiary oncology centers in Upper Egypt. Patients were treated according to the St. Jude ALL-R16 protocol. Seventeen patients were treated with a standard reinduction (regimen 1) and 65 were treated with a modified reinduction regimen in which anthracycline was added and asparaginase was reduced to 9 doses (regimen 2). Response, survival and prognostic factors were analyzed. Results: Second, complete remission (CR2) was achieved in 57% of all patients (65% with regimen 2 vs. 29% with regimen 1, p = 0.009). FLAG regimen resulted in achieving CR2 in all patients with reinduction failure. Treatment related mortality was more common with regimen 2 than with regimen 1 (34% vs. 12%, respectively). For all patients, the 2-year overall and event-free survival rates were 30% and 25%. In multivariate analysis, high initial total leukocytic count, isolated medullary relapse, regimen 1 and very early relapse were independently associated with worse event free survival (p = 0.031, 0.017, 0.037 and 0.001; respectively). Conclusions: The overall outcome of treatment of first ALL relapse in children in our region is poor. New intensive chemotherapy regimens may help in improving the treatment outcome.
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上埃及儿童急性淋巴细胞白血病首次复发:生存结局和预后因素
背景:复发是儿童急性淋巴细胞白血病(ALL)治疗失败的主要原因。目的:研究两种不同再诱导方案对首次ALL复发的治疗效果以及预测结果的预后因素。方法:一项回顾性研究,包括来自上埃及两个三级肿瘤中心的82名首次复发的ALL儿童。根据圣犹达ALL-R16方案对患者进行治疗。17名患者接受标准再诱导治疗(方案1),65名患者接受改良再诱导治疗,其中添加蒽环类药物并将天冬酰胺酶减少至9剂(方案2)。分析疗效、生存率和预后因素。结果:第二,57%的患者获得了完全缓解(CR2)(方案2为65%,方案1为29%,p=0.009)。FLAG方案导致所有再诱导失败的患者获得CR2。与方案1相比,方案2的治疗相关死亡率更常见(分别为34%和12%)。所有患者的2年总生存率和无事件生存率分别为30%和25%。在多变量分析中,高初始总白细胞计数、孤立性骨髓复发、方案1和非常早期的复发与较差的无事件生存率独立相关(分别为p=0.031、0.017、0.037和0.001)。结论:我们地区儿童首次ALL复发的治疗总体效果不佳。新的强化化疗方案可能有助于改善治疗效果。
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审稿时长
8 weeks
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