Akut miyeloblastik lösemili çocuklarda MRC-12 kemoterapi protokolü ile tedavi ve 13 yıllık izlem sonuçları
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Date
2011
Authors
Baytan, Birol
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Publisher
Uludağ Üniversitesi
Abstract
Akut miyeloblastik lösemi (AML) kemik iliğinde olgunlaşmamış hücrelerin klonal çoğalması ile karakterize neoplastik bir hastalıktır. Çocukluk çağı AML'sinde yoğun kemoterapi ve destek tedavisi ile 5 yıllık olaysız yaşam (OS) ve genel yaşam (GS) oranları %60'lara yükselmiştir.Bu çalışmada; Uludağ Üniversitesi Tıp Fakültesi Çocuk Sağlığı ve Hastalıkları Çocuk Hematoloji Onkoloji Bilimdalında, Ocak 1997- Aralık 2009 tarihleri arasında tanı alan ve tedavi edilen, 50 yeni tanı AML'li olgunun verileri ve tedavi sonuçları değerlendirildi. Bu olguların sonuçlarının incelenmesiyle elde edilen bulgular literatür bilgisiyle karşılaştırıldı.Olguların başvuruları sırasındaki semptomları, öz ve soy geçmişlerine ilişkin öyküleri, fizik bakı bulguları ve laboratuvar verileri kayıt edildi. Olgular Medical Research Council (MRC-12) protokolüne göre tedavi edildi. Bu protokole göre risk grupları, kemoterapi yanıtı, genetik özellikleri, yaş, cinsiyete göre yaşam analizleri değerlendirildi. Nüks ve ölüm oranları ve bu hastaların özellikleri incelendi. Tedaviye ilişkin akut yan etkiler değerlendirildi. İstatistik yöntemi olarak SPSS 13 programı ile Kaplan Meier yaşam analizi ve lojistik regresyon analizleri kullanıldı.Hastaların %40'ı (n:20) kız, %60'ı (n:30) erkek idi. Olguların yaş ortalaması 89±57 ay (4.5 ay-17.5 yıl) olarak saptandı. Ortalama izlem süresi 62±22.5 ay (15 gün ile 13 yıl) olarak bulundu.Beş yıllık olaysız yaşam hızı %52 ve genel yaşam hızı %60 bulundu. Çalışmamızda OS ve GS üzerine en etkili faktörler; kemoterapi yanıtı, risk grubu ve genetik özellikler olduğu bulundu. Yaş, cinsiyet, tanı lökosit sayısının OS ve GS üzerine istatistiksel anlamı olmadığı görüldü.Olguların tümünde her kür sırasında hematolojik, enfeksiyöz ve gastrointestinal yan etkilere rastlandı. Bu yan etkileri; karaciğer ve böbrek fonksiyon bozuklukları izlemiştir. En nadir ise; cilt ve nörolojik yan etkiler gözlenmiştir. Enfeksiyon dışında organ yetmezliğinden ölüm saptanmadı.iiiSerimizde nüks oranı %28 (n=14) bulundu. Tanıdan itibaren 18 aydan önce olan nükslerin yaşam oranları anlamlı olarak daha düşük olarak saptandı (p=0.013). Çalışmamızda 20 (%40) olgumuz öldü. En sık ölüm nedenlerinin nüks lösemi ve nötropenik enfeksiyon olduğu saptandı.Sonuç olarak; kliniğimizde MRC protokolü ile 5 yıllık OS %52 ve GS %60 olarak bulunmuştur. Bu sonuçlar, İngiliz MRC grubun sonuçlarına benzerdir. Ayrıca enfeksiyon önlemlerinin düzenlenmesi ve 2 yaş altı olgularda destek tedavinin güçlendirilmesi ile daha iyi yaşam oranları elde edebileceğimizi düşünmekteyiz.
Acute myeloblastic leukemia (AML) is a neoplastic disease characterized by the clonal proliferation of the immature cells in the bone marrow. The 5 years overall (OS) and event free (EFS) survivals have been recently increased to 60% with the intensive chemotherapy protocols and improved supportive care.In the current study, we evaluated the data and treatment results of 50 children diagnosed as de-novo AML in between February 1997 and December 2009 at the Department of Pediatric Hematology in Uludag University. The results were discussed under the knowledge of the other studies in the literature.The symptoms, curriculum vitae, family history, physical and laboratory findings were recorded. The patients were treated according to the Medical Research Council AML (MRC-12) chemotherapy protocol. The informed family consents were taken before starting the treatment. Survival rates were analyzed according to the risk groups, response to chemotherapy, genetic features, age, and gender and white blood cell count (WBC) at diagnosis. Relapse and death rates and the features of these children were separately evaluated. The acute side effects related to the chemotherapy at each course were also analyzed.SPSS-13 program was used for both Kaplan-Meier survival and logistic regression analysis.Twenty patients (40%) were females and the rest (n: 30;60%) were males. Their mean age and follow-up periods were 89±57months (4.5m-17.5y) and 62±22.5months (15d-13years), respectively. The 5 years OS was 60% whereas EFS was found 52%. The most effective factors influencing OS and EFS were determined as chemotherapy response, risk groups and genetic features. The age, gender and WBC count at diagnosis were found insignificant for the survival rates. The most frequent side effects observed in all courses were hematologic, infectious and gastrointestinal of which were then, followed by liver and renal dysfunctions. Skin and neurologic sideveffects were the scarcest ones. None of these side effects excluding neutropenic infection caused mortality.The relapse rate in our data was determined as 28% (n: 14). The survival rate of the children relapsed within 18monts after diagnosis were found significantly lower than the ones relapsed beyond this period (p=0.013). Twenty children (40%) died in our study group. The most frequent reasons for causing death were relapsed /resistant leukemia and neutropenic infections.In conclusion, 5 years OS and EFS in our group treated with MRC-AML-12 protocol were found 60% and 52%, respectively. This result was found similar with the result of English MRC-AML group. However, we can obtain much better survival rates with the improvements in supportive care and infection control, especially in children younger than 2 years old.
Acute myeloblastic leukemia (AML) is a neoplastic disease characterized by the clonal proliferation of the immature cells in the bone marrow. The 5 years overall (OS) and event free (EFS) survivals have been recently increased to 60% with the intensive chemotherapy protocols and improved supportive care.In the current study, we evaluated the data and treatment results of 50 children diagnosed as de-novo AML in between February 1997 and December 2009 at the Department of Pediatric Hematology in Uludag University. The results were discussed under the knowledge of the other studies in the literature.The symptoms, curriculum vitae, family history, physical and laboratory findings were recorded. The patients were treated according to the Medical Research Council AML (MRC-12) chemotherapy protocol. The informed family consents were taken before starting the treatment. Survival rates were analyzed according to the risk groups, response to chemotherapy, genetic features, age, and gender and white blood cell count (WBC) at diagnosis. Relapse and death rates and the features of these children were separately evaluated. The acute side effects related to the chemotherapy at each course were also analyzed.SPSS-13 program was used for both Kaplan-Meier survival and logistic regression analysis.Twenty patients (40%) were females and the rest (n: 30;60%) were males. Their mean age and follow-up periods were 89±57months (4.5m-17.5y) and 62±22.5months (15d-13years), respectively. The 5 years OS was 60% whereas EFS was found 52%. The most effective factors influencing OS and EFS were determined as chemotherapy response, risk groups and genetic features. The age, gender and WBC count at diagnosis were found insignificant for the survival rates. The most frequent side effects observed in all courses were hematologic, infectious and gastrointestinal of which were then, followed by liver and renal dysfunctions. Skin and neurologic sideveffects were the scarcest ones. None of these side effects excluding neutropenic infection caused mortality.The relapse rate in our data was determined as 28% (n: 14). The survival rate of the children relapsed within 18monts after diagnosis were found significantly lower than the ones relapsed beyond this period (p=0.013). Twenty children (40%) died in our study group. The most frequent reasons for causing death were relapsed /resistant leukemia and neutropenic infections.In conclusion, 5 years OS and EFS in our group treated with MRC-AML-12 protocol were found 60% and 52%, respectively. This result was found similar with the result of English MRC-AML group. However, we can obtain much better survival rates with the improvements in supportive care and infection control, especially in children younger than 2 years old.
Description
Keywords
Akut miyeloid lösemi, MRC-12 protokolü, Çocuk, Acute myeloid leukemia, MRC-12 chemotherapy protocol, Children
Citation
Baytan, B. (2011). Akut miyeloblastik lösemili çocuklarda MRC-12 kemoterapi protokolü ile tedavi ve 13 yıllık izlem sonuçları. Yayınlanmamış uzmanlık tezi. Uludağ Üniversitesi Tıp Fakültesi.