儿童急性白血病长期存活相关因素研究  

Study on factors associated with long-term survival in children with acute leukemia

作　　者：吕善根[1] 唐锁勤[1] 黄东生[1] 彭橘云[1] 冉崇蓉[1] 魏晓军[1] 王建文[1] 

机构地区：[1]解放军总医院儿科,北京100853

出　　处：《中国实用儿科杂志》2002年第2期83-85,共3页Chinese Journal of Practical Pediatrics

摘　　要：目的　分析儿童急性白血病长期存活的有关因素。方法　对 43例长期存活 5年以上急性白血病患儿的临床资料进行回顾分析。结果　自改进化疗方案后有 43例存活 5～ 2 3年以上 ,中位存活期 13 5年。37例急性淋巴细胞白血病 (ALL)中有 32例 (86 5 % )强烈化疗≤ 4周完全缓解 (CR) ,至今仍长期存活 ;>4周达CR 5例 (13 5 % )中 2例存活 5年后复发死亡。若起病时白细胞数虽高 ,如能在 2～ 4周获CR后坚持规范治疗 ,仍可改善预后。 37例ALL中 18例应用大剂量甲氨蝶呤 (HD MTX)后无一例发生髓外白血病。 43例中有 9例行干细胞移植治疗。结论　小儿ALL多药联合诱导若 2～ 4周内获CR有益于预后。积极稳妥开展HD MTX有益于髓外白血病防治。Objective To analyze factors associated with long term survival in children with acute leukemia. Methods Clinical data is analyzed in 43children with leukemia who had at least 5 years event free survival(EFS).Results Forty three patients who had survived for 5 to 23 years, with mean of 13.5 years were studied. 32 of 37(86.5%) patients with ALL had reached CR within 4 weeks post induction chemotherapy and all of them are in status of CCR; the remaining 5 patients(13.5%) had got CR after 4 weeks post induction chemotherapy and 2 of them relapsed 5and 6 years later, respectively. Prognosis could be improved in those with high WBC count at diagnosis in case of CR completion within 2～4 weeks after induction. No extramedullary leukemia occurred in 18 patients who had received HDMTX+IT. Nine patients had received autologous peripheral blood stem cell transplantation and have got long term EFS. Three patients have got long term survival who received the chemotherapy at outpatient service except first in hospital, due to fanacial problem. Conclusion A combined multi-drug induction chemotherapy is beneficial to childhood ALL and the patients could get excellent survival if the patients got CR within 2～4 weeks post induction. HDMTX+IT is much helpful to prevent the extramedullary leukemia.Stem cell transplantation can be used in those refractory patients. Minimal residual disease detection is helpful for the treatment monitoring. Outpatient service may be reduce the cost of medicine.

关 键 词：急性白血病 儿童 长期存活 疗效 

分 类 号：R733.71[医药卫生—肿瘤]