CAJ | 학술논문

目的初步评估所采用的2004全国小儿血液病学术会议关于儿童急性淋巴细胞白血病诊疗建议方案(简称04方案)的诊断、治疗效果.方法对2004年10月-2007年6月282例急性淋巴细胞性白血病(简称急淋)患儿,参照04方案诊疗建议进行诊断、分型及治疗;按危险度分型进行统计并用SPSS统计软件对结果进行生存分析.结果 2004年10月-2007年6月88例新诊急淋患儿接受了04方案化疗,总完全缓解(CR)率为91.30%(63/69),标、中危组CR率均为100%(37/37),高危组CR率为81.25%(26/32);总4年无病生存率(EFS)为(59.73±7.22)%,标、中危患儿的EFS分别为(75.60±9.71)%和(65.50±11.69)%,高危组EFS为(44.03±12.36)%;总复发率为18.18%,骨髓复发占87.50%,单纯的中枢复发占12.50%;化疗相关死亡率为9.09%,其中诱导缓解治疗阶段因感染死亡7例(7.95%),真菌是主要病原菌.结论应用04方案对儿童急淋进行诊治疗效满意;化疗第19天(d_(19))骨髓幼稚细胞数和临床危险度分型是独立的预后指标,大剂量甲氨蝶呤对中枢神经系统白血病的预防起到了重要作用;诱导期化疗过强,化疗相关死亡率高.
목적 초보평고소채용적2004전국소인혈액병학술회의관우인동급성림파세포백혈병진료건의방안(간칭04방안)적진단、치료효과.방법 대2004년10월-2007년6월282례급성림파세포성백혈병(간칭급림)환인,삼조04방안진료건의진행진단、분형급치료;안위험도분형진행통계병용SPSS통계연건대결과진행생존분석.결과 2004년10월-2007년6월88례신진급림환인접수료04방안화료,총완전완해(CR)솔위91.30%(63/69),표、중위조CR솔균위100%(37/37),고위조CR솔위81.25%(26/32);총4년무병생존솔(EFS)위(59.73±7.22)%,표、중위환인적EFS분별위(75.60±9.71)%화(65.50±11.69)%,고위조EFS위(44.03±12.36)%;총복발솔위18.18%,골수복발점87.50%,단순적중추복발점12.50%;화료상관사망솔위9.09%,기중유도완해치료계단인감염사망7례(7.95%),진균시주요병원균.결론 응용04방안대인동급림진행진치료효만의;화료제19천(d_(19))골수유치세포수화림상위험도분형시독립적예후지표,대제량갑안접령대중추신경계통백혈병적예방기도료중요작용;유도기화료과강,화료상관사망솔고.
Objecfive To analyze the clinical and laboratory data from acute lymphoblastie leukemia(ALL)patients and the results of treatment using 04 Protocol(suggested by the Pediatric Hematology Group of Chinese Medical Association in 2004).Methods This study included 88 children with ALL below the age of 18 years during the period from October 1,2004 to June 30,2007.Minimal inhibitory concentration(MIC)and clinical risk classification were done and the new chemotherapy regimen was used according to the protocoL Patients were stratifiod into low-risk(LR),medium-risk(MR),and high-risk (HR)groups.Life table method was used to estimate survival rate and statistical analysis was done by using software SPSS for Windows.Results From October 2004 to June 2007.88 childhood ALL patients were treatod with the 04 ProtocoL Sixty-three(91.30%)patients attained complete remission(CR)and 17 patients lost to follow up.The overall 4-year-event-free survival(EFS)rate(±SE)was(59.73±7.22)%.EFS was(75.60±9.71)%in the LR(n=30),(65.50±11.69)%in the MR(n=20)and(44.03±12.36)%in the HR.Relapse occurred in 18.18%of patients.Seven(7.95%)0f 88 patients with ALL died during he induction therapy.Infection was the most comnlon cause of death.Conclusion The outcome of patients treated with the 04 Protocol was favorable.Clinical risk classifieation and the leukemia cells of D19 are independent predictors of prognosis of ALL Hish dose methotrexate played an important role in prevention and treatment of central nervous system leukemia.The mortality rate of this chemotherapeutic protocol during induction therapy was high.