儿童急性白血病发病年龄与预后的关系

Relationship Between the Age of Childhood Leukemia and Outcome of Chemotherapy

本文分析和总结我院于１９８８年到１９９２年中收治的１５例婴儿白血病的临床特征和疗效，以阐明儿童急性白血病的发病年龄与化疗疗效的关系。资料与方法：（１）病儿：婴儿白血病１５例，男１１例，女４例，年龄４～１８个月。其中急性淋巴细胞白血病（ＡＬＬ）１０例；急性髓系白血病（ＡＭＬ）５例（１例Ｍ４，３例Ｍ５，１例Ｍ６）。（２）临床特征：治疗之前，５例病儿（４例ＡＬＬ，１例ＡＭＬ）伴有中枢神经系统白血病（ＣＮＳＬ），８例具有明显的肝脾肿大，６例髓外浸润明显（唾液腺，皮肤等），５例外周血象白细胞＞２０×１０９／Ｌ。（３）系统化疗：ＡＬＬ应用美国Ｓ．Ｊｕｄｅ医院所推荐的联合化疗方案，顺序如下：①诱导治疗ＰＶＤＬ（泼尼松、长春新碱、柔红霉素、左旋门冬酰胺酶）。②巩固治疗ＣＡＴ（环磷酰胺、阿糖胞苷、６巯基嘌呤）。③ＣＮＳＬ预防ＨＤ－ＭＴＸ（大剂量甲氨喋呤）和定期鞘内注射化疗。④维持治疗和定强化治疗：方案从略。（４）ＣＭＬ治疗方案和顺序①诱导治疗ＨＯＡＰ（高三尖杉、长春新碱、阿糖胞苷、泼尼松）或ＤＡ（柔红霉素，阿糖胞苷）。②巩固和强化治疗ＤＡ方案或阿糖胞苷＋竹叶乙甙。结果：９例病儿获完全缓解（ＣＲ），其中６例分别已获持续缓解（Ｃ?

Objective:To study the relationship between the age of childhood leukemia and the outcome of chemotherapy,We analyzed the clinical features and the treatment results of the infantile leukemia treated in our hospital from 1988 to 1992.Methods:15 cases of infantile leukemia (11 male,4 female)were in the study.The age of the patients ranged from 4 to 18 months (median 11 months).There were 10 cases of ALL and 5 cases of AML(1 case of M4,3 cases of M5,1 case of M6).Before treatment,5 cases(4 ALL,1 AML)were complicated with central nervous system leukemia(CNSL),8 cases with obvious hepatomegaly and/or splenomegaly,and 6 cases with other parts of extramedullary infiltration(salivary glands and/or skin),5 cases had peripheral WBC counts of >20×10 9/L.The patients with ALL were treated with S.Jude protocols that consisted of PVDL for induction,CAT for consolidation,HD-MTX for prophylaxis of CNSL,regular intensive therapy,maintenance and so on,whereras the patients with AML were treated with HOAP or DA for induction,DA and/or VM26 plus AraC for consolidation as well as for regular intensive therapy.Results: 6 cases died within 2 weeks of the initial therapy,3 cases relapsed after having got CR for 1 to 8 months.Therefore,only 6 cases (5 cases of ALL and 1 case of M5)had got CCr for 7,4,3,2,2 years and 10 months, respectively.Conclusion: Our results showed that,in contrast to elder childhood patients,infantile leukemia remains with worse prognosis for the patients with more malignant leukemia types of pathomorphism,severe extramedullary infiltration,high incidence of CNSL and with high periphral WBC counts in initial diagnosis,and moreover,refranctory to the chemotherapy eseciall in AML.