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本文结合我院1988年11月—1993年3月收治的54例儿童淋巴瘤细胞白血病(LML)的临床资料,进行了临床分析探讨。按勇氏标准诊断。男44例,女10例,最小1岁,最大15岁。Ⅲ、Ⅳ期50例,病理类型高度、中度恶性32例(占66.7％)。临床表现除淋巴瘤及白血病常见症状、体征外,因原发部位及转移部位不同,临床表现复杂多样。骨髓增生活跃或明显活跃,粒、红、巨核系统不同程度受抑、淋巴系统恶性增生,出现特异的淋巴瘤细胞。外周血红细胞、血色素,血小板呈不同程度减少,部分病例白细胞异常增高;分类中淋巴细胞增高、或可见淋巴瘤细胞。治疗以CHOP方案化疗为主,首次CR7例,PR33例,PD9例,未治5例。近期有效率74％,CR期40天～21个月,中位缓解期6.5个月。生存时间10天～60个月,中位生存期7.5个月。讨论中指出,LML的发生与病理类型高度、中度恶性,尤其是淋巴母细胞型、免疫分型T细胞型的密切相关,纵隔病变伴胸水或淋巴细胞明显增高者与发生白血病;多组浅表淋巴结肿大、肝脾进行性肿大;晚期病例;骨髓增生明显活跃伴粒、红、巨核系统受抑者及外周血白细胞持续增多者易患白血病。儿童LML与ALL在骨髓、外周血、临床表现,临床发生发展及病理组织学方面有差别。
In this paper, clinical data of 54 cases of childhood lymphoma cell leukemia (LML) admitted to our hospital from November 1988 to March 1993 were analyzed and discussed clinically. According to Yong’s standard diagnosis. 44 males and 10 females, the youngest 1 year old, the oldest 15 years old. Stage Ⅲ, Ⅳ 50 cases, pathological type of high and moderate malignant 32 cases (66.7%). In addition to the clinical manifestations of lymphoma and leukemia common symptoms and signs, due to the different parts of the primary site and metastasis, the clinical manifestations of complex and diverse. Bone marrow hyperplasia was active or significantly active, granular, red, megakaryocytes suppressed to varying degrees, the malignant proliferation of the lymphatic system, the emergence of specific lymphoma cells. Peripheral blood red blood cells, hemoglobin, platelets decreased to varying degrees, in some cases abnormal increase in leukocytes; classification of lymphocytes increased, or lymphoma cells can be seen. Treatment with CHOP regimen chemotherapy, the first CR7 cases, PR33 cases, PD9 cases, 5 cases not treated. The recent efficiency of 74%, CR 40 days to 21 months, the median remission of 6.5 months. Survival time 10 days to 60 months, the median survival of 7.5 months. Discussion pointed out that the occurrence of LML and the pathological type of high, moderately malignant, especially lymphoblastic type, immune type T cell type is closely related to mediastinal lesions with pleural effusion or lymphocytes were significantly higher and the occurrence of leukemia; Table lymph nodes, liver and spleen progressive enlargement; late cases; significant proliferation of bone marrow with granulocyte, red, megakaryocyte system and peripheral white blood cells continued to increase those susceptible to leukemia. Children LML and ALL in bone marrow, peripheral blood, clinical manifestations, clinical development and histopathological differences.