氟达拉滨联合阿糖胞苷及粒细胞集落刺激因子方案治疗儿童复发难治性急性白血病的疗效

Therapeutic Effect of Fludarabine,Cytarabine and Granulocyte Colony-Stimulating Factor Regime on Relapsed and Refractory Acute Leukemia in Children

目的探讨氟达拉滨联合阿糖胞苷及粒细胞集落刺激因子(FLAG)方案应用于儿童复发难治性急性白血病的疗效和不良反应。方法 2007年2月-2010年3月共有10例复发难治性急性白血病患儿接受FLAG方案治疗。男8例,女2例;中位年龄8岁(4～12岁)。急性髓细胞性白血病(AML)患儿8例,其中AML-M25例,AML-M43例;ALL患儿2例,均为B-ALL患儿;复发患儿6例,难治性患儿4例。FLAG方案具体为:氟达拉滨25mg.m-2.d-1,第1-5天静脉滴注;阿糖胞苷2g.m-2.d-1,第1-5天静脉滴注;粒细胞集落刺激因子150～300μg.d-1皮下注射,第0天开始,用至中性粒细胞≥0.5×109L-1。结果 10例患儿中6例(60%)获完全缓解,1例(10%)获部分缓解,3例(30%)未缓解,总有效率70%。8例AML患儿中6例(75%)获完全缓解,2例(25%)未缓解。2例B-ALL患儿中1例获部分缓解,1例未缓解。化疗的不良反应主要为血液学不良反应,未见严重的非造血系统不良反应。无化疗相关死亡。结论 FLAG方案治疗儿童复发难治性白血病具有一定疗效,特别对复发难治性AML患儿更有效。此方案的不良反应可以耐受,可作为儿童复发难治性急性白血病治疗方案之一。

Objective To primarily explore the efficacy and adverse effects of the combination of fiudarabine,cytarabine and granulocyte colony-stimulating factor（G-CSF）（FLAG regime）therapy for relapsed and refractory acute leukemia in children.Methods Ten children were treated with the FLAG regime for relapsed and refractory acute myeloid leukemia （AML）and acute lymphoblastic leukemia（ALL）from Feb.2007 to Mar.2010.There were 8 male and 2 female,with mean age 8 years（ranging from 4 to 12 years）.AML was diagnosed in 8 children,AML-M2 in 5 cases,AML-M4 in 3 cases.ALL was diagnosed in 2 children,both were B-ALL.Six children had refractory disease,and 4 cases were in relapse.FLAG regime included：fludarabine 25 mg·m^-2·d^-1,days 1-5;cytarabine 2 g·m^-2·d^-1,days 1-5;G-CSF 150-300 μg·d^-1,from day 0 to neutrophils ≥0.5×10^9 L^-1.Results Complete remission was obtained in 6 children（60%）,partial remission was obtained in 1 child（10%）,and 3 children were considered non-response（30%）.The total effective rate was 70%.For 8 children with AML,6 children had achieved complete remission（75%）,2 children had non-response（25%）.While in children with ALL,1 child got partial remission,and the other one had non-response.Myelosuppression and infections due to neutropenia were the most frequent adverse effects,severe nonhematologic toxicity were not observed in these children.And there were no chemotherapy-related death.Conclusions The FLAG regime is effective in treatment of children with relapsed and refractory acute leukemia,especially for the children with the relapsed and refractory AML.The adverse effects from this regime were well tolerated.FLAG regime can give children with relapsed and refractory acute leukemia another chance.