以大剂量阿糖胞苷为主的联合化疗在儿童急性白血病中的应用  

Evaluation of high-dose cytosine arabinoside as an intensified therapy in children with acute leukemia

作　　者：于亚平[1] 过国英[1] 傅元风 樊忠明[1] 伏洁[1] 刘光陵[1] 

机构地区：[1]南京军区南京总医院儿科,江苏南京210002

出　　处：《医学研究生学报》2000年第B05期6-6,共1页Journal of Medical Postgraduates

摘　　要：目的 :探讨大剂量阿糖胞苷 ( HDAC)治疗儿童急性白血病的效果和不良反应。　方法 :应用 HDAC治疗 3例急性髓细胞白血病 (每次 2 .0 g/m2 ,每 12 h1次 ,共 6次为一个疗程 )和 4例高危型急性淋巴细胞白血病 (每次1.0 g/m2 ,每 12 h1次 ,共 8次为一个疗程 )共 16个疗程 ,九个疗程在 HDAC结束后使用惠尔血 ( 2～ 3μg/kg)皮下注射 ,连续 10～ 14天。　结果 :6例按计划完成 HDAC治疗 ,并继续用常规方案治疗者 ,在 2 0～ 42个月的随访期内无病生存 ,1例 AL L- L3型在一个疗程 HDAC后出现中枢神经系统白血病复发 ,骨髓仍缓解 ,7个月后放弃治疗 .骨髓严重抑制和感染是最主要的不良反应 ,加用惠尔血可使粒细胞缺乏的持续时间缩短 ,感染发生率降低。　结论 :以 HDAC为主的联合化疗方案可安全地用于儿童急性白血病的强化治疗 ,对降低复发。Objectives: To investigate the efficacy of highdose cytosine arabinoside(HDAC) in the treatment of children with acute leukemia and its side effects. Methods: Three children with acute myeloid leukemia(AML) and 4 with high risk acute lymphoblastic leukemia(ALL) received 16 courses of HDAC(2.0 g/m2 every 12 hours for 6 doses for AML and 1.0 g/m2 every 12 hours for 8 doses for ALL) plus Daunorubicin(50 mg/m2) or Idarubicin(10 mg/m2) for postremission intensified treatment. In 9 courses , granulocytecolony stimulating factor(Filgrastim,2~3 μg/kg daily for 10~14 doses) was administered intramuscularly after the end of HDAC. Results: One case developed central nervous system leukemia after 1 course of HDAC. Other 6 cases have got continuous complete remission for 20~42 months after HDAC courses were accomplished. Severe and prolonged myelosuppression was frequent. The use of Filgrastim has been showed to shorten the period of neutropenia and reduce the infectious complications. Other side effects were tolerable and infrequent. Conclusions: Postremission intensified therapy with HDAC for childhood AML and ALL was safe and may result in decrease in recurrence and prolongation of remission.

关 键 词：白血病 儿童 阿糖胞苷 惠尔血 治疗 

分 类 号：R733.710.5[医药卫生—肿瘤]