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目的探讨儿童方案应用于青少年及成人急性淋巴细胞白血病(ALL)的临床疗效。方法分别应用儿童方案(治疗组)和成人方案(对照组)巩固维持治疗青少年及成人ALL。观察比较两种方案的完全缓解率、长期生存率、化疗毒副作用和并发症。结果 32例青少年及成人ALL诱导2周完全缓解(CR)率78.13%(25/32),4周完全缓解率96.88%(31/32),其中应用儿童方案治疗的16例患者复发时间4～48个月,中位复发时间14.5个月,1年持续完全缓解率(CCR)率62.5%(10/16),3年CCR率18.9%(3/16)。应用成人方案治疗的16例患者复发时间3～32个月,中位复发时间9.5个月,1年CCR 43.8%(7/18)。儿童方案组患者生存期明显优于成人方案组,差异有统计学意义(P<0.05)。治疗组中,14～24岁组平均生存期28.3个月,25～40岁组平均生存期27.2个月,两组生存率比较差异无统计学意义(P>0.05)。结论青少年及成人ALL应用儿童方案疗效治疗疗效更佳,同时提示儿童方案可能对较大年龄组同样具有较好的疗效,且毒副作用轻,值得推广。
Objective To investigate the clinical efficacy of children’s programs in adolescent and adult acute lymphoblastic leukemia (ALL). Methods Consolidate the maintenance treatment of adolescents and adults with children program (treatment group) and adult program (control group) respectively. The complete remission rate, long-term survival rate, side effects and complications of chemotherapy were observed and compared between the two regimens. Results The complete remission (CR) rate was 78.13% (25/32) in 2 adolescents and adults, and the complete remission rate was 96.88% (31/32) in 4 weeks. The recurrence time of 16 patients treated with children regimen was 4 ~ At 48 months, the median time to recurrence was 14.5 months. The 1-year CCR rate was 62.5% (10/16) and the 3-year CCR rate was 18.9% (3/16). Sixteen patients treated with adult regimen recovered from 3 to 32 months with a median recurrence of 9.5 months and a 1 year CCR of 43.8% (7/18). The survival rate of children in the program group was significantly better than that of the adult program group, the difference was statistically significant (P <0.05). The treatment group, 14 to 24 years old group average survival time of 28.3 months, 25 to 40 years old group average survival time of 27.2 months, there was no significant difference between the two groups (P> 0.05). Conclusion The therapeutic effect of children’s programs in children and adolescents with adult ALL is better. At the same time, it is suggested that the children’s programs may have the same efficacy in older age groups with less toxic and side effects, which is worthy of promotion.