细胞体外药敏试验与急性淋巴细胞白血病患儿临床治疗及预后的研究  

Clinical Study on Cellular Drug Sensitivity Test in vitro and Treatment of Childhood Acute Lymphoblastic Leukemia and Its Prognosis

作　　者：孙黎明[1] 李苗[1] 杜淑旭[1] 武万水[1] 支文靖[1] 唐泓[1] 孙艳玲[1] 

机构地区：[1]北京世纪坛医院儿童血液/肿瘤科,北京100038

出　　处：《实用儿科临床杂志》2011年第3期174-176,共3页Journal of Applied Clinical Pediatrics

基　　金：留学回国人员科研启动基金(教外司留[2001]345)

摘　　要：目的分析在临床危险因素分型基础上,依据细胞体外药物敏感性确定个体化治疗方案治疗儿童ALL的可行性。方法留取50例ALL患儿治疗前骨髓/外周血液标本,行细胞体外药敏试验;将白血病细胞对泼尼松（PRED）、长春新碱（VCR）、门冬酰胺酶（ASP）3种药物敏感程度进行积分（PVA积-分）。每种药物的积分为1分（高度敏感）、2分（中度敏感）、3分（不敏感/耐药）,3种药物总积分分为3＋4分（高度敏感）、5~7分（中度敏感）、8＋9分（不敏感/耐药）;临床按传统危险因素分型之后,依据PVA积-分为患儿制定个体化治疗方案。结果 50例患儿全部完成诱导缓解治疗,完全缓解（CR）率100%。中位随访时间63个月。复发、死亡14例,无事件生存（EFS）率64.3%;PVA积-分3＋4分24例,死亡1例,EFS率96.1%;PVA积-分5~7分15例,死亡4例,EFS率79.7%（t=3.737,P=0.002）;PVA积-分8＋9分11例,死亡9例,EFS率54.2%（t=2.448,P=0.028）。结论在危险因素分型基础上,依据PVA积-分确定个体化治疗方案不仅避免标危ALL患儿因耐药使化疗方案强度不足,CR之后易复发,导致生存期缩短,而且可避免高危ALL患儿因过强化疗后的治疗相关毒性及死亡。PVA积-分是对ALL传统危险因素分型的补充。Objective To determine an individualized therapy for childhood acute lymphoblastic leukemia（ALL） based on cellular drug sensitivity in vitro by means of risk-group stratification.Methods Initial bone marrow and peripheral blood samples of 50 ALL children were used for drug sensitivity assessment in vitro through the colorimetric methyl-thiazol-tetrazolium（MTT） assay;a score was derived for each child from the sensitivity to 3 drugs-prednisone,vincristine and asparaginase（PVA-Score）.For each drug,a score of 1（highest sensitivity） to 3（resistance） was given,thus an overall score of 3＋4 scores suggested highest sensitivity,5-7 scores intermediate sensitivity,and 8＋9 scores suggested drug-resistance.PVA-Score was used after the traditional risk-group stratification to determine an individua-lized therapy for ALL children.Results All 50 cases of ALL children had completed induction therapy with 100% complete remission（CR）.The medium follow-up period was 63 months.Among all children,14 children experienced relapses or died,and the event-free survival（EFS） rate was 64.3%.Among the 24 children with PVA-Score 3＋4 scores,1 child died（EFS rate was 96.1%）,and among the 15 children with PVA-Score 5-7 scores,4 children died（EFS rate was 79.7%）（t=3.737,P=0.002）;and of the 11 children with PVA-Score 8＋9 scores,9 children died（EFS rate was 54.2%）（t=2.448,P=0.028）.Conclusions Individualized therapy based on PVA-Score in addition to risk group stratification can not only avoid relapses caused by insufficient therapy intensity in standard risk patients with drug resistance,but also reduce chemotherapy related toxicity and lower the death due to overtreatment of high risk patients.In conclusion,PVA-Score is a necessary complement to the traditional risk-group stratification.

关 键 词：淋巴细胞白血病 急性 药物敏感试验 四甲基偶氮唑蓝法 儿童 

分 类 号：R733.7[医药卫生—肿瘤]