儿童急性淋巴细胞白血病单中心临床研究  

Clinical study on childhood acute lymphoblastic leukemia diagnosed and treated with 04 Protocol in Chongqing, China

作　　者：梁筱灵[1] 宪莹[1] 戴碧涛[1] 徐酉华[1] 苏庸春[1] 王世一[1] 陆玲玲[1] 李欣[1] 于洁[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：《中华儿科杂志》2009年第12期939-941,共3页Chinese Journal of Pediatrics

摘　　要：目的初步评估所采用的2004全国小儿血液病学术会议关于儿童急性淋巴细胞白血病诊疗建议方案（简称04方案）的诊断、治疗效果。方法对2004年10月-2007年6月282例急性淋巴细胞性白血病（简称急淋）患儿，参照04方案诊疗建议进行诊断、分型及治疗；按危险度分型进行统计并用SPSS统计软件对结果进行生存分析。结果2004年10月-2007年6月88例新诊急淋患儿接受了04方案化疗，总完全缓解（CR）率为91．30％（63／69），标、中危组CR率均为100％（37／37），高危组CR率为81．25％（26／32）；总4年无病生存率（EFS）为（59．73±7．22）％，标、中危患儿的EFS分别为（75．60±9．71）％和（65．50±11．69）％，高危组EFS为（44．03±12．36）％；总复发率为18．18％，骨髓复发占87．50％，单纯的中枢复发占12．50％；化疗相关死亡率为9．09％，其中诱导缓解治疗阶段因感染死亡7例（7．95％），真菌是主要病原菌。结论应用04方案对儿童急淋进行诊治疗效满意；化疗第19天（d19）骨髓幼稚细胞数和临床危险度分型是独立的预后指标，大剂量甲氨蝶呤对中枢神经系统白血病的预防起到了重要作用；诱导期化疗过强，化疗相关死亡率高。Objective To analyze the clinical and laboratory data from acute lymphoblastic leukemia （ALL） patients and the results of treatment using 04 Protocol （suggested by the Pediatric Hematology Group of Chinese Medical Association in 2004 ）. Methods This study included 88 children with ALL below the age of 18 years during the period from October 1,2004 to June 30, 2007. Minimal inhibitory concentration （MIC） and clinical risk classification were done and the new chemotherapy regimen was used according to the protocol. Patients were stratified into low-risk （LR） , medium-risk （ MR）, and high-risk （HR） groups. Life table method was used to estimate survival rate and statistical analysis was done by using software SPSS for Windows. Results From October 2004 to June 2007, 88 childhood ALL patients were treated with the 04 Protocol. Sixty-three （91.30%） patients attained complete remission （CR） and 17 patients lost to follow up. The overall 4-year-event-free survival （EFS） rate （ ± SE） was （59.73 ± 7.22） %. EFSwas （75.60±9.71）% in the LR（n=30）, （65.50±11.69）% in the MR（n=20） and （44.03 ± 12.36）% in the HR. Relapse occurred in 18. 18% of patients. Seven （7.95%） of 88 patients with ALL died during he induction therapy. Infection was the most common cause of death. Conclusion The outcome of patients treated with the 04 Protocol was favorable. Clinical risk classification and the leukemia cells of D19 are independent predictors of prognosis of ALL. High dose methotrexate played an important role in prevention and treatment of central nervous system leukemia. The mortality rate of this chemotherapeutic protocol during induction therapy was high.

关 键 词：儿童 白血病 淋巴细胞 急性 回顾性研究 

分 类 号：R733.71[医药卫生—肿瘤] R733.7[医药卫生—临床医学]