低剂量EA-高白细胞性急性白血病诱导前治疗的疗效观察

Study on the therapeutic effects of new therapy regimen-low dose EA on patients with hyperleukocytic acute leukemia before induction therapy

目的：高白细胞急性白血病（HLAL）进展迅速,早期死亡率极高。本文观察标准诱导化疗前治疗方法———低剂量EA降低患者体内白血病细胞负荷的疗效。方法：收集2007年6月-2009年11月住院HLAL患者42例,同时以同期398例非HLAL作为对照。经血液学和骨髓检查确诊为急性髓细胞白血病（AML）28例,急性淋巴细胞白血病（ALL）14例。36例（包括所有ALL患者）诊断明确后立即给予低剂量EA诱导化疗前治疗以降低白血病细胞,6例先采用羟基脲,但效果欠佳,后换用低剂量EA方案。应用低剂量EA后,白细胞降至40×109/L以下时,采用标准MA、HA、DA或VDCLP方案诱导缓解治疗。结果：42病例（28例AML和14例ALL）低剂量EA应用第2天开始白细胞下降明显,平均3~5 d外周血白细胞计数至40×109/L以下,1例血常规恢复后复查骨髓达完全缓解,余患者进一步诱导缓解治疗2个疗程后完全缓解率47.62%（20/42,包括全部14例ALL患者）,部分缓解率28.57%（12/42）,总有效率76.19%（32/42）,与非HLAL组的缓解率无差别（P〉0.01）,化疗中无一例出现肿瘤溶解综合征。1例白细胞数〉400×109/L,住院24 h内脑出血而死亡。结论：低剂量EA能迅速降低HLAL肿瘤负荷,及时改善临床症状,早期死亡率低,并且对淋巴系和髓系白血病细胞均有良好疗效,同时花费较低,为有效的HLAL诱导化疗前治疗新方法。

Objective：Patients with hyperleukocytic acute leukemia（HLAL） have poor prognosis and high early mortality rate.The therapeutic effects of new therapy regimen——low dose EA（Etoposide＋cytrarabine） on the patients with hyperleukocytic acute leukemia（HLAL） before standard induction therapy was investigated.Method：42 patients with newly diagnosed pediatric HLAL at Xijing Hospital from Jun 2007 to Nov 2009 were reviewed.Of them,there were 28 cases of acute myeloid leukemia（AML） and 14 cases of acute lymphocytic leukemia（ALL）.398 non-HLAL cases were served as control group.After diagnosis,36 patients were treated with low dose EA in order to reduce white blood cell（WBC） before standard induction therapy.6 patients were treated laterly with low dose EA because the effect of early administration of Hydroxycarbamide（HU） was not good.When WBC counts were below 40×109/L after the treatment of low dose EA,the patients were treated by standard MA、HA、DA or VDCLP for induction therapy.Result：The WBC counts in all the patients treated with low dose EA dropped distinctly.The WBC counts decreased below 40×109/L 3~5 days after EA treatement.After 2 cycles introduction therapy,the rate of complete recovery（CR） was 47.62%（20/42） including ALL patients,part recovery rate was 28.57%（12/42）,and total efficiency rate was 76.19%（32/42）.No tumor lysis syndrome occurred.1 patient died of cerebral hemorrhage with WBC counts 400×109/L.Conclusion：Early appropriate management can reduce the mortality in HLAL patients.Low dose EA could rapidly reduce tumor burden,improve clinic symptom and avoid high incidence of outer marrow infiltration either in AML or ALL.Meanwhile the cost was lower and the patients had more chance to accept induction therapy.Low dose EA was a new effective treatment before induction therapy for HLAL.