Đánh giá hiệu quả điều trị bệnh bạch cầu cấp dòng lympho T ở trẻ em theo phân nhóm nguy cơ bằng phác đồ FRALLE 2000 tại Bệnh viện Truyền máu Huyết học

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Tác giả: Thị Thu Hiền Đào, Gia Khánh Đinh, Nghĩa Huỳnh, Thiện Ngôn Huỳnh, Quốc Thành Nguyễn, Thị Thanh Trúc Võ

Ngôn ngữ: vie

Ký hiệu phân loại: 618.9 Pediatrics and geriatrics

Thông tin xuất bản: Tạp chí Y học Việt Nam (Tổng hội Y học Việt Nam), 2022

Mô tả vật lý: 338-344

Bộ sưu tập: Metadata

ID: 500801

Thêm vào giỏ

Describe clinical features, biological characteristics, long-term effects, and complications of treatment for childhood T-cell acute lymphoblastic leukemia by risk stratification with FRALLE 2000 protocol. Methods: A retrospective case series study of 65 patients who under 16 years of age, treated with FRALLE 2000 protocol at Blood Transfusion and Hematology hospital from 2011 to 2021. Results: Early T-cell precursor (ETP) acute lymphoblastic leukemia has accounted for 30,8%. Overall complete post-induction response rate was 92,3%, all patients achieved induction failure were ETP group. Overall survival (OS) and the Event-free survival (EFS) after 5 years were là 35,9% and 31,3%. The cumulative incidence of relapse 10 years was 57.5%. Patients with ETP were significantly more likely to have positive Post-induction MRD (PI - MRD) than that of non-ETP (80% vs 42,9%, p=0,026. Positive PI - MRD showed a higher risk of relapse and was the most powerful prognostic factor, indicating significant differences in EFS (p=0.005), OS (p=0,035). Infectious complications are prominent, encountered at all stages of treatment. Treatment-Related Mortality was 12,3 %. 3% deaths were due to acute heart failure during induction treatment. Conclusion: Post-induction MRD positive has increased the risk of relapse and 80% ETP patients had PI-MRD positive. There was no difference in replase rate as well as EFS and OS between the ETP and non-ETP groups. The overall complete post-induction rate of patients achieving remission is quietly high, accounted for 92,3%. However 44,6% of patients will relapse. Treatment-related mortality was 12,3 %, mainly due to sepsis, pneumonia.Mô tả đặc điểm lâm sàng, sinh học và đánh giá hiệu quả, biến chứng điều trị bệnh bạch cầu cấp dòng lympho T ở trẻ em theo phân nhóm nguy cơ bằng phác đồ FRALLE 2000. Phương pháp: Thiết kế nghiên cứu hồi cứu - mô tả hàng loạt ca Đối tượng nghiên cứu: 65 bệnh nhi nhỏ hơn 16 tuổi mới được chẩn đoán Bạch cầu cấp dòng lympho taị Bệnh viện Truyền máu Huyết học từ năm 2011 đến 2021. Kết quả: Phân nhóm Early T cell precursor (ETP) chiếm 30,8% mẫu nghiên cứu. Tỷ lệ lui bệnh hoàn toàn sau giai đoạn tấn công là 92,3%. Tất cả những trường hợp kháng trị đều thuộc nhóm ETP. Ước tính thời gian sống toàn bộ (OS) và thời gian sống không sự kiện (EFS) sau 5 năm lần lượt là là 35,9% và 31,3%. Tỷ lệ tái phát tích lũy 10 năm là 57,5%. Nhóm ETP có tỉ lệ MRD dương tính sau tấn công cao hơn nhóm non-ETP (80% so với 42,9%
p=0,026). MRD dương tính sau tấn công làm tăng nguy cơ tái phát bệnh và là yếu tố tiên lượng mạnh mẽ nhất, cho EFS,OS khác biệt có ý nghĩa (p=0,005 vs p=0,035). Biến chứng nổi bật là nhiễm trùng, gặp trong mọi giai đoạn của điều trị. Tỉ lệ tử vong liên quan đến điều trị (TMR) là 12,3%, có 3% tử vong do suy tim cấp khi điều trị giai đoạn tấn công. Kết luận: MRD dương tính sau tấn công làm tăng nguy cơ tái phát bệnh. 80% bệnh nhân trong nhóm ETP có MRD dương tính sau hóa trị tấn công. Chưa có sự khác biệt về tỉ lệ tái phát cũng như EFS và OS giữa 2 nhóm ETP và non-ETP. Tỉ lệ bệnh nhân đạt lui bệnh sau tấn công khá cao, chiếm 92,3%. Tuy nhiên 44,6% BN sẽ tái phát sau đó. Tỉ lệ tử vong có liên quan đến điều trị là 12,3%, chủ yếu do nhiễm trùng huyết, viêm phổi.

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