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目的探讨儿童高危ALL的危险因素及疗效,改善ALL患儿的预后。方法回顾性分析本院2004年10月-2007年12月初诊ALL患儿的临床资料,按2004年全国小儿血液病会议通过的儿童ALL诊疗建议,具有危险因素的41例患儿进入研究。发病年龄8～12个月或10～14岁者共21例,白细胞≥50×109 L-1者20例(48.78%),初发时伴髓外浸润15例(36.59%),T淋巴细胞性白血病10例(24.39%),有不利的细胞遗传学改变5例(12.20%),窗口治疗不敏感12例(29.27%),2个疗程未获缓解1例(2.44%)。以2006年1月为界,此前应用新华-99方案化疗,此后用上海儿童白血病协作组2005方案(ALL-2005方案)进行化疗。应用SPSS 13.0软件进行统计学分析。结果随访至2010年6月,中位随访时间32.08个月(2～68个月)。40例经1个疗程诱导后缓解,缓解率97.56%;10例(24.39%)复发,3例(7.32%)在治疗过程中死于感染。预期30个月无事件生存率(EFS)和总生存率(OS)分别为69.60%和73.30%。窗口治疗不敏感和诱导6周未获缓解2个危险因素作为单变量对EFS和OS影响有明显差异。结论评判ALL的危险因素对选择治疗方案和预后判断均非常重要。强烈的联合化疗、造血干细胞移植作为补充手段治疗儿童高危白血病,能够获得较好的疗效。
Objective To explore the risk factors and the therapeutic effect of high risk ALL in children and to improve the prognosis of children with ALL. Methods Retrospective analysis of clinical data of our hospital from October 2004 to December 2007 in our hospital from 2004 to 2004. According to the pediatric ALL diagnosis and treatment recommendations adopted by the National Pediatric Hematology Conference in 2004, 41 children with risk factors were enrolled in the study. Twenty-one patients (48.78%) with leukocyte≥50 × 109 L-1, 15 patients (36.59%) with extramedullary infiltration, T lymphocytes There were 10 cases of leukemia (24.39%), 5 cases (12.20%) with unfavorable cytogenetic changes, 12 cases (29.27%) insensitive to window treatment and 1 case (2.44%) without remission in 2 courses. In January 2006 as a community, after the application of Xinhua-99 chemotherapy, then with the Shanghai Children’s Leukemia Group 2005 program (ALL-2005 program) for chemotherapy. SPSS 13.0 software was used for statistical analysis. The results were followed up to June 2010 with a median follow-up of 32.08 months (range 2-68 months). 40 cases were relieved after one course of induction, the remission rate was 97.56%; 10 cases (24.39%) were relapsed and 3 cases (7.32%) died of infection during the course of treatment. The expected 30-month event-free survival (EFS) and overall survival (OS) were 69.60% and 73.30%, respectively. There was a significant difference in the effects of window-based therapy and induction of 6-week untreated 2 risk factors as univariate variables on EFS and OS. Conclusion The risk factors for evaluating ALL are very important for the choice of treatment and prognosis. Strong combination of chemotherapy, hematopoietic stem cell transplantation as a supplementary means of treatment of children with high-risk leukemia, can get better effect.