儿童急性淋巴细胞白血病分型及其不同治疗方案与预后的临床研究  

The clinical research among morphology and immunophenotype and different chemotherapeutic protocols in childhood acute lymphoblastic leukemia

作　　者：刘四喜[1] 徐宏贵[1] 方建培[1] 黄绍良[1] 周敦华[1] 钟凤仪[1] 魏菁[2] 

机构地区：[1]中山大学附属第二医院儿科,广州510120 [2]中山大学附属第二医院医学研究中心

出　　处：《临床血液学杂志》2003年第5期216-219,共4页Journal of Clinical Hematology

摘　　要：目的:研究儿童急性淋巴细胞白血病(ALL)的细胞形态学、免疫表型分型及不同方案治疗与预后的相关性。方法:采用骨髓涂片染色进行细胞形态学检查,采用单克隆抗体(McAb)和流式细胞仪(FCM)进行免疫表型检测。结果:103例儿童ALL患者中,67例(65.05％)为L_1型,33例(32.04％)为L_2型,无L_3型,3例(4.91％)为其他。行免疫分型的87例中,58例(66.67％)为B系表达,12例(13.79％)为T系表达,10例(11.49％)为B系、髓系混合表达,3例(3.45％)为T系、B系混合表达,1例(1.15％)为T系、髓系混合表达,1例(1.15％)为B系、T系、髓系混合表达,2例(2.30％)为髓系表达。采用XH-88方案治疗25例,缓解率92％,复发率52.17％,死亡率43.48％;协作组方案治疗41例,缓解率92.68％,复发率36.84％,死亡率55.26％;SUM-99’方案治疗29例,缓解率93.10％,复发率18.52％,死亡率14.81％。结论:结合免疫分型与细胞形态学分型,将儿童ALL患者分为标危(SR)、中危(IR)和高危(HR)三组,按型采用不同的治疗方案对提高儿童ALL缓解率和降低其复发率有重要意义。Objective: To investigate the correlation among disease of morphologic classification, immunologic classification.different chemotherapeutic protocols and patients' prognosis in childhood acute lymphoblastic leuke-mia(ALL). Method:Cell immunophenotype was determined by flow cytometry. 95 patients with ALL were taken with xinhua-88'protocol ,the national childhood co-operation protocol of ALL and the therapeutic protocol of Sun Yat-sen University of Medical Sciences(SUM-99'protocol) differently, furthermore being followed-up. Result: A-mong 103 ALL,of 67(65. 05%)were diagnosed as ALL-L1,out of 33(32. 04%)as ALL-L2, 3(4. 91%)as others. Immunophenotypical analysis was carried out in 87 cases,lymphoblast of 58 cases(66. 67%)expressed B-cell antigen,of 12 cases(13. 79% ) T-cell antigen, of 10 cases(11. 49%) showed combination of B and myeloid antigen, 3 (3. 45%)combined B and T-cell antigen, 1 cased. 15%) T and myeloid antigen, and 1 case (1. 15%) T and B and myeloid antigen, 2 cases(2. 30%) were showed myeloid antigen . Twenty-five cases were treated with xinhua-88' protocol,and the CR rate was 92% ,the remission time was 24 days , the relapse was 52. 17% ,and the mortality was 43. 48%. Meanwhile 41 cases were treated with the national protocol, and the CR rate was 92. 68% , the relapse was 36. 84% ,and the mortality was 55. 26%. Moreover 29 cases were treated with the SUM-99'protocol, and the CR rate was 93. 10% ,the relapse was 18. 52% , the mortality was 14. 81% , however eight cases were given up in this group. Conclusion: These results suggested that childhood ALL in the protocol divided into standard-risk group, intermediate-risk group and high-risk group improve the prognosis of the leukemia. Immunophenotype has important value as the guidline for the choice of potocol with ALL.

关 键 词：白血病 淋巴细胞性 急性 免疫分型 治疗 预后 

分 类 号：R733.71[医药卫生—肿瘤]