10岁以上儿童及青少年急性淋巴细胞性白血病的临床总结

Evaluation of clinical outcome in over 10 years children and adolescents with acute lymphoblastic leukemia

目的总结64例年龄为10～17岁急性淋巴细胞性白血病（以下简称急淋）的临床疗效。方法64例患儿中男44例，女20例均接受99-XH—ALL方案治疗，随访1～116个月，平均随访时间为43个月，并应用SPSS11．0软件进行无事件生存期和总生存期的分析。结果64例患儿中24例（37．5％）无不良临床特征，早期治疗反应良好，40例（62．5％）有不良临床特征及早期治疗反应不佳，64例惠儿中58例达到CR，其中55例一疗程达到CR（85．94％），总CR率为90．63％，平均CR时间为38．45（25～56）天；13例复发（22．41％），平均复发时间为CR后15．77（2～58）个月；9例死亡（14．06％），其中4例死于感染，5例死于复发；随访中有21例失访，其中7例为复发后，10例为CR后，4例为未CR者，3例患儿接受移植，其中2例存活，1例死于移植后疾病复发，4例患儿出现并发症，占11．76％，其中1例乙肝（50个月），3例股骨头坏死（25、32、60个月），1例女孩4个月时发生第二肿瘤恶性葡萄胎，治愈存活至今。64例病人7年EFS：（37．31±7．23％），7年OS：（54．40±6．51％）。结论10岁以上儿童及青少年的急淋预后不良，长期生存率低。

Objective To analyse 64 patients with acute lymphoblastic leukemia aged from 10-17 years, the therapeutic efficacy of these patients were evaluated. Methods In total of 64 patients with acute lymphoblastic leukemia, 44 boys and 20 girls were received 99-XH-ALL protocol for treatment, follow-up 1 -116 months, the event-free survival（EFS） and overall survival（OS） were evaluated by the Kaplan-meier medthod with SPSS 11.0 software. Results In all these patients, 24 patients （ 37.5% ） were good response in early induction and 40 patients （62.5%） with poor clinical characteristics were poor response in early induction. 58 patients （90.63%） achieved a complete remission （CR） in an average of 38.45 days（25 -56 days）, 9 patients （ 14.06% ） died, four of them died of infection, five of them died of relapsed. 21 patients lost follow-up. 3 patients received Allo-PBSCT, one of them relapsed, the other were cured. 4 patients（ 11.76% ） developed with hepatitis B and whirlbone necrosis in 25 -60 months. 1 patient developed secondary sarcomas in 54 months. The 7-years EFS in 67 patients was （37.31 ± 7.23 ）%, the OS was （54.40 ± 6. 51 ）%. Conclusion over 10 years children and adolescents with acute lymphoblastic leukemia were poor outcome and lower long-survival.