论文部分内容阅读
对小儿急性淋巴细胞性白血病(ALL)进行化疗,多数病例完全缓解率(CR)达90%以上,而成人ALL 采用与小儿相同的疗法则CR 率低,很难达到长期缓解。为此,1983年以来开始进行较强的联合化疗协作研究,最近报道已获得与小儿ALL 相似的疗效,现介绍如下:一、预后因素ALL 根据形态学及免疫学可分为许多类型,各型对治疗反应各不相同。按形态分类有的认为L-1型比L-2型预后好,但多数认为两者无差异。一般认为L-3型缓解率低,缓解期及存活期短,中枢神经系统(CNS)受累率亦高。按白血病细胞表现型分类,C-ALL 预后最好;但以前认为预后不良的T-ALL 采用强力治疗已获极好疗效;B-ALL 较为罕见,预后最差;null-ALL成人占20%以上,一般虽易于缓解,但缓解期短;而杂种白血病预后不良。其他预后不良因素尚有年龄(>30岁)、初诊时白细胞(>30000～35000/mm~3)、完全缓解需要时间(4周以上)、性别(男性较女性差)以及染色体异常等。特别是成人ALL 的t 值:t(9;22)、t(4;11)及
In children with acute lymphoblastic leukemia (ALL) chemotherapy, most cases of complete remission rate (CR) of 90% or more, while adults with the same treatment of children with pediatric CR rate is low, it is difficult to achieve long-term relief. To this end, since 1983 began a strong collaborative chemotherapy study, the recent report has been obtained with similar efficacy in children with ALL, are described below: First, the prognostic factors ALL morphological and immunological can be divided into many types, all types The response to treatment varies. According to the morphological classification, L-1 type is better than L-2 type, but most of them think there is no difference. L-3 type generally considered low response rate, remission and short survival, the central nervous system (CNS) involvement rate is also high. According to the phenotype of leukemic cells, the prognosis of C-ALL is the best. However, T-ALL with poor prognosis has been treated with powerful therapy before. The B-ALL is rare and the prognosis is the worst. More than 20% of the patients with null-ALL , Although generally easy to ease, but the remission period is short; and hybrid leukemia prognosis is poor. Other adverse prognostic factors are age (> 30 years), white blood cells (> 30000 ~ 35000 / mm ~ 3) at initial diagnosis, time required for complete remission (more than 4 weeks), gender (worse for males than females) and chromosomal abnormalities. In particular, adult t t values: t (9; 22), t (4; 11) and