Treatment Results of the TPOG-NHL92 Protocols for Childhood Non-Hodgkin's Lymphomas in Taiwan: A Report from the Taiwan Pediatric Oncology Group (TPOG)

以TPOG-NHL92方案治療兒童非何傑生淋巴瘤之成果：台灣兒童癌症研究群(TPOG)之報告

楊兆平(Chao-Ping Yang) ； 洪悠紀(Iou-Jih Hung) ； 江東和(Tang-Her Jaing) ； 林凱信(Kai-Hsin Lin) ； 林東燦(Dong-Tsamn Lin) ； 盧孟佑(Meng-Yao Lu) ； 梁德城(Der-Cherng Liang) ； 陳淑惠(Shu-Huer Chen) ； 劉希哲(Hsi-Che Liu) ； 蕭志誠(Chih-Cheng Hsiao) ； 徐山靜(San)

《Acta Paediatrica Taiwanica》 41卷4期 (2000/08) Pp. 193-204

https://doi.org/10.7097/APT.200008.0193

摘要

台灣兒童癌症研究群(TPOG)於1992啓用4個TPOG-NHL92化學治療方案來治療兒童之非何傑生氏淋巴瘤(NHL)：TPOG-NHL92用來治療Ⅰ、Ⅱ期之各種組織亞型NHL（治療期爲8個月），92LB、92SNC、及92LC則分別用於治療第Ⅲ、Ⅳ期之lym-phoblastic (LB)，small noncleved cell (SNC)，及large cell (LC)淋巴瘤，治療期分別爲2年、5個月、及1個年。新診斷爲surface Igm-positive之急性淋巴性白血病(B-ALL)也用92SNC方案治療，併入SNC群分析。自1992年1月至1998年6月，由13家TPOG所屬醫院共登錄了200例新診斷爲NHL（包括B-ALL）之病童。共140男孩及60女孩，診斷時年齡由2個月至18.3歲不等，中值爲8.2歲。198例組織亞型分佈如下：LB 54例(27.3%)，SNC（包括17例B-ALL）94例(47.5%)，及LC 50例(25.2%)。病期分別爲：第Ⅰ及Ⅱ期共31例(15.3%)，第Ⅲ期85例(42.9%)，第Ⅳ83(41.9%)。腫瘤之主要原發部位在縱隔腔者38例，在腹部者62例，在頭、頸部者共53例　。
200例中，2例未治療即死亡，2例資料不足，15例選用之方案不合規定，5例未完成induction治療即失去追蹤，剩下176位隔腔，列入以下分析，追蹤至1999年8月31日的結果如下：在induction中死於併發症者共9例
（8例SNC，1 LC）；22例在induction結束後，未能達到完全緩解；而達到緩解的共145例(82.4%)。緩解後失去追蹤的有7例；緩解期中死於併發症的6例；26例(18.8%)複發；1例LB第Ⅳ期患者在結束二年化療後不久即發生次發性骨髓性白血病；剩下105例(62.1%)到08/31/1999仍在持續緩解中(CCR)，其緩解期間由18個月至89個月不等（中值：49個月）。在此105(29 LB,51 SNC,25 LC)CCR病例中，除2例LB外，已愉部結束化療。七年之LVEvent-free survival (EFS)在LB、SNC、及LC群分別爲63.5%、61.5%、及65%（P值0.8298）；在stageⅠ/Ⅱ,stage Ⅲ,及stageⅣ之7-year EFS分別爲73%,68.9%,及50.3%（P值0.0212）；而使用4個方案TPOG-92LD,92LB,92SNC,及92LC群之7-year EFS則分別爲78.8%,65.6%,60%及52.6%（P值0.1969）。
我們的結論是：此臨床治療結果顯示似乎只有發病時之病期和預後有關；各組織亞型經以上不同方案之治療，結果無明顯統計學上有意義之差異。欲提昇國內兒童淋巴瘤治療成果，仍待更多的努力。

關鍵字

非何傑生淋巴瘤 ； 兒童期 ； 化學治療 ； 治療結果

並列摘要

A nation-wide chemotherapeutic trial for childhood non-Hodgkin’s lymphoma (NHL) was conducted by the Taiwan Pediatric Oncology Group (TPOG). Four TPOG-NHL92 protocols based on stage and histology were activated in 1992: TPOG-92LD (treatment duration: 8 months) was used for localized (stages Ⅰ/Ⅱ) NHL with any histology, 92LB (2 years), 92SNC (5 months), and 92LC (1 year) for advanced (stages Ⅲ/Ⅳ) lymphoblastic (LB), small non-cleaved cell (SNC), and large cell (LC) lyrnphoma, respectively. From January 1992 through June 1998, 200 children with newly diagnosed NHL from 13 member hospitals of TPOG were enrolled. There were 140 boys and 60 girls. Their ages at diagnosis ranged from 2.4 months to 18.3 years with a median of 8.2 years. There were 54 (27.3%) patients with LB, 94 (47.5%) with SNC including B-cell acute lymphoblastic leukemia (B-ALL), and 50 (25.2%) with LC. StagesⅠ, Ⅱ, Ⅲ, and Ⅳ (including B-ALL) of the disease comprised 5%, 10%, 43%, and 42% of cases, respectively. There were 176 patients eligible for evaluation of treatment results. The remission rate of induction was 82.4%, induction failed in 22 (12.5%) patients, and nine patients died during induction. As of August 31, 1999, 26 patients relapsed, six died during remission, one patient developed secondary acute myelomonocytic leukemia, and 105 patients remained in continuous remission with a median remission duration of 49 months. The event-free survival (EFS) at 7 years was 63.5%, 61.5% and 65% for LB, SNC, and LC groups (P=0.8298). The 7-year EFS for stages Ⅰ/Ⅱ, Ⅲ, and Ⅳ of the disease was 73%, 68.9%, and 50.3% (P=0.0212), respectively. We concluded that following the strategy of stratification of therapy, only disease stages had prognostic significance in this study. More efforts are needed to improve our treatment results.

並列關鍵字

non-Hodgkin's lymphoma ； childhood ； chemotherapy ； treatment results