CAJ | 학술논문

目的观察氟达拉滨( Flud)联合阿糖胞苷(Ara-C)及粒细胞集落刺激因子(G-CSF)( FLAG)方案治疗儿童难治及复发性急性白血病(AL)的疗效及患者不良反应.方法 9例复发及难治性AL患儿接受了FLAG方案治疗,Flud每天30 mg/m2,第1天至第5天,静脉滴注30 min；Ara-C每天2 g/m2,Flud应用后4h静脉滴注,第1天至第5天.G-CSF 5μg·kg-1·d-1,中性粒细胞＜0.5×109/L时开始应用,用至中性粒细胞≥1×109/L.9例患儿中急性髓系白血病(AML)8例,急性淋巴细胞白血病(ALL)1例；难治性AL5例,复发性AL4例.结果 9例患儿中经1个疗程化疗达完全缓解(CR)6例,部分缓解(PR)2例,总有效(CR+PR)率88.9％(8/9).6例CR患者中2例行造血干细胞移植,现均无瘤生存；患者主要不良反应是感染、骨髓抑制和胃肠道反应.结论 FLAG方案治疗儿童难治及复发性AL缓解率高,不良反应可以耐受,是治疗儿童难治及复发性AL的一个选择,为后续的造血干细胞移植提供了机会.
목적 관찰불체랍빈( Flud)연합아당포감(Ara-C)급립세포집락자격인자(G-CSF)( FLAG)방안치료인동난치급복발성급성백혈병(AL)적료효급환자불량반응.방법 9례복발급난치성AL환인접수료FLAG방안치료,Flud매천30 mg/m2,제1천지제5천,정맥적주30 min；Ara-C매천2 g/m2,Flud응용후4h정맥적주,제1천지제5천.G-CSF 5μg·kg-1·d-1,중성립세포＜0.5×109/L시개시응용,용지중성립세포≥1×109/L.9례환인중급성수계백혈병(AML)8례,급성림파세포백혈병(ALL)1례；난치성AL5례,복발성AL4례.결과 9례환인중경1개료정화료체완전완해(CR)6례,부분완해(PR)2례,총유효(CR+PR)솔88.9％(8/9).6례CR환자중2례행조혈간세포이식,현균무류생존；환자주요불량반응시감염、골수억제화위장도반응.결론 FLAG방안치료인동난치급복발성AL완해솔고,불량반응가이내수,시치료인동난치급복발성AL적일개선택,위후속적조혈간세포이식제공료궤회.
Objective To observe the clinical efficacy and adverse reaction of the combination of fiudarabine,cytarabine and granulocytecolony-stimulating factor (G-CSF) (FLAG regime) therapy for refractory and relapsed acute leukemia in children. Methods From 2004 to date, a total of 9 patients with relapsed and refractory acute leukemia patients in our hospital accepted the treatment, in 9 cases 8 cases were AML,1cases were ALL; in 9 cases 5 cases were refractory acute leukemia, 4 cases were recurrent acute leukemia.Results Among the 9 cases,6 cases with 1 cycles of chemotherapy achieved complete remission (CR),CR rate was 66.7 ％ (6/9); partial remission (PR) rate was 22.2 ％ (2/9),total efficiency (CR+PR) was 88.9 ％.In 6 CR patients 2 underwent hematopoietic stem cell transplantation, are disease-free survival; this regimen' s main adverse reactions were infection,bone marrow depression and gastrointestinal reaction.Conclusion The remission rate of FLAG regimen in the treatment of children with refractory and relapsed acute leukemia is relatively high, adverse reactions were tolerable; the FLAG program is a choice for the treatment of children with refractory and relapsed acute leukemia,which provides the opportunity for subsequent hematopoietic stem cell transplantation.