两种化疗方案治疗儿童急性非淋巴细胞白血病的疗效比较  

The clinical study of Acute Myeloid Leukemia in childhood Treated by different protocols

作　　者：张永红[1] 吴敏媛[1] 耿兰增[1] 胡亚美[1] 

机构地区：[1]首都医科大学附属北京儿童医院,100045

出　　处：《中国小儿血液》2004年第3期119-122,共4页China Child Blood

摘　　要：目的 　比较两种不同方案对儿童AML的治疗效果。方法 　按不同治疗方案将 56名儿童分为两组 :A组 32名 ,采用以DA或IA为主的传统诱导方案 ,随后给VM2 6+Ara -C巩固治疗及以POAP为主的维持治疗 ,疗程 3年左右。B组 2 4名则采用改良的BFM方案 ,总疗程 2年左右。随访截止日期 2 0 0 0年 1 2月 31日。结果 　 56例诊断时中位年龄 7.8岁。男女比例为 1∶1。M2 为最常见亚型占 4 8%。高白细胞血症者 7例 ( 1 2 .5% )。 1 9例病人 ( 34% )伴骨髓外侵润 ,其中 2例有原发的CNSL。早期死亡 ( 2个月内 ) 3例占 5.4 % (A组 1名 ,B组 2名 )。第一疗程后的平均缓解率为72 % (A组 6 2 .6 % ,B组 87.5% ,P <0 .0 5)。 3年无病存活率 (EFS)分别为A组 36 .8% ,B组 6 5.6 % ,两组比较有显著差异 (P <0 .0 5)。A组病人复发率明显高于B组分别为 50 %及 1 6 % (P <0 .0 0 1 ) ,诱导及巩固中合并症的发生率及死亡率B组高于A组分别为 9/2 4和 8/32 ,但差异无显著性。结论 　强烈的诱导方案及巩固方案 ,可以提高AML病人的远期存活率 ,减少复发。特别对有高危因素的病人如高白细胞血症、M4、M5 亚型者效果更佳。过多延长维持治疗时间并不能改善预后。强烈化疗增加了合并症发生的频率及危险性 ,从而需要更有力的支持治疗。Objective To compare the treatment result of two groups which were treated in different protocol. Methods Total of 56 newly diagnosed cases were included in the study. The treatment regimens were divided into two main groups. There were 32 patients treated by the group A regimen which was considered as less intensive. The induction protocols included daunorubicin or idarubicin and cytosine arabinoside. These patients were further treated with one or two courses of consolidation treatment which included VM 26and Ara-C. Maintenance treatment was also given to those patients for three years. A total of 24 patients in group B were treated with a more intensive chemotherapy regimen which was modified from the BFM(1983)protocols. The patients were followed until their death or up to 31th December 2000. Results The mean age of diagnosis was 7.8 years. Male: female was 1∶1. M 2 was the commonest subtypes(48%); Hyperleucocytosis occurred in 7 cases(12.5%) and 19 cases(34%) with extramedullary involvement, CNS leukemia were diagnosed in 2 patients at the time of diagnosis. Early deaths and non-leukemia deaths during remission occurred in 3 patients(5.4%). Complete remission (CR) rates after one course of thrapy varied from 62.6%, 87.5% in two groups. The 3 years disease free survival(EFS) of Group A and Group B patients were 36.8% and 65.6%. The relapse rate in group A was much higher than group B(50% vs 16%). There were more severe infection and hemorrhage during the period of induction and early consolidation in group B than group A. Conclusions Intensive chemotherapy improved the cure rate and reduced the relapse rate in AML especially for those patients who has the identify risk factors, such as hyperleucocytosis, M 4,M 5. Long phase maintenance treatment was not shown to be beneficial in AML patients. The very intensive treatment usually increases the possibility of severe complications. The improvement in supportive treatment is necessary.

关 键 词：化疗方案 治疗 儿童 急性非淋巴细胞白血病 长春新碱 6-巯基嘌呤 阿糖胞苷 柔红霉素 

分 类 号：R733.71[医药卫生—肿瘤]