荣成98方案诊治儿童急性淋巴细胞白血病的临床分析  

Clinical study on childhood acute lymphoblastic leukemia diagnosed and treated with Rongcheng 98 Protocol.

作　　者：于洁[1] 徐酉华[1] 宪莹[1] 戴碧涛[1] 李兴[1] 陆玲玲[1] 

机构地区：[1]重庆医科大学附属儿童医院血液肿瘤科,400014

出　　处：《中国实用儿科杂志》2005年第3期158-160,共3页Chinese Journal of Practical Pediatrics

摘　　要：目的　分析近几年利用荣成98方案对重庆地区儿童淋巴细胞白血病(ALL)的诊治状况,初步评估1999年全国ALL诊疗建议的方案的应用效果。方法　对2 0 0 0年1月至2 0 0 4年4月重庆医科大学附属儿童医院新诊ALL患儿2 31例,参照1999荣成诊疗建议进行诊断、分型及治疗,分年龄组进行统计分析比较。结果　近3年ALL病例数逐渐增加;患儿初诊时临床表现较重;婴儿高白细胞(WBC)者为80 .0 0 % ,而10岁以上患儿为14 .2 8% ;骨髓增生程度与WBC计数不完全一致。B ALL和T ALL分别占86 . 76 %和13. 2 4 % ,合并髓系标志表达者14 . 71% ;具有染色体数目或结构异常的患者标本为76 % ,激素实验不敏感者10 . 14 % ,而HR ALL占4 9. 6 6 %。接受化疗者5 8例,完全缓解率89 .5 8% ;骨髓复发9例,复发率17% ;4 1例患儿坚持治疗,进入维持治疗2 1例,无病生存率为83%。结论　所在医院近3年ALL病例逐渐增加;本文ALL患儿初诊时的临床表现较重;高白细胞血症见于多数婴儿白血病患儿;坚持规范的化疗是决定预后的最重要因素;荣成98方案治疗结果显示完全缓解率89. 5 8% ,无病生存率83% ,复发率17% ,大剂量氨甲蝶呤对中枢神经系统白血病预防起到了重要作用。Objective To analyse the clinical and laboratory data from ALL patients and the treatment results using Rongcheng 98 Protocol (suggested by the Pediatric Hematology Group of China Medical Association in 1999).Methods 231 ALL patients were enrolled in this study.MIC and clinical risk classification were done and the new chemotherapy regimen was used according to the protocol.The data were analyzed using Microsoft Excel.Results The number of the patients increased with the years.The clinical manifestations at diagnosis were more severe than the referred data.The infant ALL with high WBC count accounted for 80.00%,but 14.28% in the older.The patients with B-ALL and T-ALL accounted for 56.76% and 13.24% respectively.B-ALL/T-ALL with My antigen expression accounted for 14.71%.86% bone marrow samples showed the chromosome number and/or structures abnormalities.10.14% of the patients showed bad response to predison,but HR-ALL accounted for 49.66%.Total 58 patients agreed with the chemotherapy and 21 entered the maintenance stage.CR rate reached 89.58%,9 patients had relapse and DFS at this stage was 87%.Conclusion The number of the children with ALL increases.MICM and risk factor classification are important for prognosis and treatment decision.Insistent and formal chemotherapy is the most important factor in this study.The new protocol showed good results in CR rate,extramedullary ALL prevention and DFS.

关 键 词：儿童 急性淋巴细胞性白血病 临床表现MIC分型 治疗 

分 类 号：R72[医药卫生—儿科]