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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。对化疗难以根治的白血病患儿可选用干细胞移植
Objective To analyze the long-term survival of children with acute leukemia related factors. Methods The clinical data of 43 children with long-term survival of more than 5 years with acute leukemia were retrospectively analyzed. Results After the improvement chemotherapy regimen, 43 cases survived for more than 5 to 23 years and the median survival time was 13 5 years. Of 37 acute lymphoblastic leukemia (ALL) cases, 32 (86.5%) had complete remission (CR) ≤ 4 weeks after chemotherapy and still survived for a long time; 2 of 5 CR patients (13.5%) survived more than 4 weeks 5 years after the recurrence of death. If the onset of leukocyte count is high, if 2 to 4 weeks after CR adhere to standard treatment, can still improve the prognosis. Eighteen out of 37 ALL patients developed extramedullary leukemia after using high-dose methotrexate (HD MTX). Nine of 43 patients underwent stem cell transplantation. Conclusions Multi-drug combination therapy in pediatric ALL may be beneficial if prognosis is achieved within 2 to 4 weeks. Active and safe HD MTX beneficial extramedullary leukemia prevention and treatment. Chemotherapy difficult to cure children with leukemia can choose stem cell transplantation