| Objective：Analysis of children’s scheme of CCLG-ALL2008and adult programeffectiveness and safety in the youth in ALL to compare, in order to provide basis forthe treatment of adolescent ALL.Materials and Methods:Retrospective analysis of54cases of ALL patients diagnosed from March,2009to December，2013in cancer center of our hospital treated by adult ALL regimen (Agroup) and CCLG-ALL2008(B group) aged15~30years. We compared thechemotherapy doses of remission induction therapy,14days,28days the CR rate,recurrence free survival, overall survival and evaluated the effectiveness ofchemotherapy related toxicitywith WHO standards. At the same time, we comparedthe infection and bleeding and other complications between the two groups.Results：(1) Basic information: In54cases of AYAs ALL, there were30cases of male,24cases of female, the median age was19,41cases were high-risk patients and13caseswere moderate-risk respectively. The median follow-up time was9.5months (1~40).21cases were treated by the CCLG-ALL2008regimen,33cases were treated by adultALL regimen. Between children group and adult group, there were no significantdifferences distribution in gender, age, disease subtype, the number of white bloodcells, cell genetics, outside the marrow infiltration and prednisone sensitive test,which made the two groups comparable.(2) Differences in treatment: in treatmentgroup B,MTX for total was (12.445±6.583) g/m2, significantly greater than ingroup A (5.738±3.607) g/m2, the difference was statistically significant (P <0.05);L-asp of group B for total was (25.642±17.159) million units/m2, more than ingroup A (11.229±19.967) million units/m2, difference was statistically significant(P=0.001); Total hormone dose of group B was more than in group A, whichdifference was statistically significant (P=0.022). In application of dexamethasone, group B was wore than in group A, two groups respectively (0.860±0.281) g/m2and (0.467±0.282)g/m2the difference was statistically significant (P <0.05); Andin prednisone dose, no statistical differences were between the two groups (P=0.557).The amount of six mercaptopurine of group B was (5.436±2.844) g/m2, more than ingroup A (1.074±0.707)g/m2, the difference was statistically significant (P <0.05).In ara-C, anthracycline, CTX, group A was more than group B, the difference wasstatistically significant (P<0.05); And in dose of vinblastine, there were no significantdifference (P>0.05). Compared to the average number of lumbar puncture in bothgroups, there was no statistically significant difference (P=0.910). The median timebefore matainence was9months, respectively group A9months(4~18) vs group B9months (4~16), there was no statistically significant difference (P=0.662). Thenumber of treatment course before Maintain, less than group B, the median of group Awas8(3~11) vs group B12(4~13), the difference was statistically significant (P<0.05).(3) The overall treatment: group A, a total of33cases of patients, including31casesas a course of CR after induction chemotherapy, in subsequent treatment process, atotal of20cases of recurrence,1case was lost to follow-up,2cases gone withhematopoietic stem cell transplantation after consolidation therapy; A total of21patients with group B were all CR after induction chemotherapy and in subsequenttreatment process, a total of3cases of recurrence,1case lost to follow-up,5casesgone with hematopoietic stem cell transplantation after consolidation therapy.(4)Thenearer future curative effect: A, B group of patients with CR rate after14days were36.4%and90.5%respectively, the difference was statistically significant (P<0.05);CR rate were66.7%and100%respectively,28days difference was statisticallysignificant (P=0.003); For CR time significantly shorter than group B, the differencewas statistically significant (P=0.049). Of molecular biology alleviated time, group Bwas obviously shorter than group A, the median time of9months (8~9) respectively,and2months (1~3), there was no statistically significant difference (P=0.136). Ofgenetics alleviated the time, there was no significant statistical difference (P=0.817),and the median time was2months.(4) The survival analysis:1year OS rate of groupA was at a rate of86.0%,1year RFS rate was53.0%,2year OS at a rate of80.2%,2 years RFS rate was34.5%, the OS rates was61.3%at3years,3years RFS rate was18.4%; In group B,1year OS at a rate of100.0%,1year RFS rate was83.3%,2yearsOS at a rate of100.0%,2years of RFS rate was66.6%,3years OS rates was100.0%,3years RFS rate was66.6%. Group A was obviously better than B in the RFS, thedifference was statistically significant (P=0.024), there was no statistically significantdifference in OS (P=0.085).(5) Chemotherapy related toxicity: Concerned withhematology toxicity,50cases of patients were with bone marrow inhibition(granulocyte lack in degree IV),38cases of patients were with IV degree of plateletdecreased,23cases of patients with coagulopathy abnormal. Difference in neutrophilsreduced is statistically significant (P=0.009), the incidence of a lack of granulocytein group A was higher than group B; There was no statistical difference in plateletreduction (P>0.05). Coagulopathy abnormal in two groups of patients was major infibrinogen (FBG) reduced, and APTT, TT extended. Among them the occurring rate ofcoagulopathy, group B was76.2%(16cases), significantly higher than group A(21.2%,7cases), the difference was statistically significant (P <0.05). Innonhematologic toxicity, the amount and degree of the two groups of patients withheart, liver, kidney damage and gastrointestinal reaction were similar, there was nostatistically significant difference;(6) Infection and bleeding complications: numberof patients with bone marrow suppression (granulocyte lack) and incidence of fevercaused by the suppression between the two groups was different (5.5vs3,90.9%vs.57.1%), the difference was statistically significant (P <0.05). With clear focalinfection, group A was28(84.8%), group B was13(61.9%), difference wasstatistically significant (P=0.028). Incidence of pneumonia (42.4%) in which Agroup was obviously higher than that of group B (9.5%), the difference wasstatistically significant (P=0.010). The incidence of infection of other parts andsepsis, etc., was no statistical differences in the two groups (P>0.05). There was nostatistically significant difference in bleeding (P=0.454). But in group A,treatment-related death occurred in2cases, the rate was6.1%, the cause of death wascerebral hemorrhage. Conclusion：(1) Compared with adults, CCLG-ALL2008children regimen includes less bonemarrow suppression drugs, more bone marrow inhibitory drugs, larger density oftreatment.(2) CCLG-ALL2008children plan has better curative effect in patientswith AYAs ALL, CR rate of14days,28days, time befor first CR, are better thanadults.(3) CCLG-ALL2008children scheme affects obviously the RFS of AYAs ALLpatients better than that of adults, with OS no difference between them.(4) CCLG-ALL2008children with lower incidence of fever incidence, higher frequency andincidence of pneumonia than adults, the incidence of fibrinogen reduced is higher, butthere is no serious bleeding occurred after the treatment, which shows that the schemecan be tolerated by AYAs ALL. |
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