低强度、低费用方案治疗儿童非高危急性淋巴细胞白血病

Less Intense and Lower Cost Protocol for Children with Non-High-Risk Acute Lymphoblastic Leukemia

目的探索采用减低强度、低费用的治疗方案治疗儿童非高危急性淋巴细胞白血病(ALL)的可行性及其在发展中国家的现实意义。方法1999年5月-2006年9月本院儿科病房初诊的ALL患儿52例。男40例,女12例;年龄1～14岁。家长在充分知情的情况下自主选择是否接受低强度低费用经济方案治疗。经济方案的长期疗效用Kaplan-Meier生存分析方法统计,住院费用来自医院病案室。结果选择经济方案治疗的患儿均来自低收入家庭。52例诱导失败3例。其中2例诱导未缓解,1例诱导未结束放弃治疗。诱导缓解率94.2%,非高危ALL患儿4a和7a预期无事生存率(pEFS)分别为72.8%和67.2%,4a和7a预期无病生存率(pDFS)分别为74.3%和68.6%。住院化疗费用2.3万～5.1万元(中位数3.2万)。结论低强度经济方案治疗儿童非高危ALL似能达到合理的EFS和DFS,对低收入家庭儿童的治疗有现实意义。

Objective To investigate the practical significance of less intense and lower cost protocol to cure children with non - high - risk acute lymphoblastic leukemia（ALL） in developing countries such as in China. Methods Under the circumstances of informed consent, parents of 52 children （40 males, 12 femalse, aged from 1 to 14 years old） with newly diagnosed ALL from May 1999 to Sep. 2006, decided whether to accept less intense and lower cost protocol for the treatment of their children. The long term treatment outcome of the protocol was estimated by the method Kaplart - Meier, and the data of hospitalization cost was obtained from the case record department. Results Children accepted the protocol from low income families. Three children failed to induce. Two of them were non - remission ,the other one gave up the treatment when the course of treatment was not over. The complete remission rate was 94.2%. For the patients with non - high - risk ALL, the 4 years and 7 years possibility event - free survi-val（pEFS） were 72.8% and 67.2% ,4 years and 7 years possibility disease - free survival（pDFS） were 74.3% and 68.6% ,respectively. The median impatient chemotherapy cost was 32 000 yuan（23 000 -51 000 yuan）. Conclusions This trial shows that less intense protocol appears to achieve a reasonable EFS and DFS for childhood non - high - risk ALL with a much lower cost. This will be especially important in areas with low family income.