FLAG方案治疗儿童复发性急性淋巴细胞白血病及非霍奇金淋巴瘤短期疗效观察

The short-term efficacy of FLAG regime for relapsed childhood ALL and NHL

目的观察FLAG方案治疗儿童复发性急性淋巴细胞白血病(ALL)及非霍奇金淋巴瘤(NHL)短期疗效及安全性。方法回顾性分析经FLAG方案[氟达拉滨30 mg/m2,d 1～5,阿糖胞苷2 g/m2,d 1～5,粒细胞集落刺激因子5μg/(kg.d)]治疗的19例复发性ALL和NHL患儿临床资料,其中ALL 15例(初诊时高危8例,中危2例,低危5例),NHL 4例(临床分期为Ⅳ期);早期复发12例,晚期复发7例。观察其疗效、生存时间及不良反应。结果经1个疗程后,11例(73.3%)ALL患儿达完全缓解(CR),其中高危5例,中危1例,低危5例;2例(50.0%)NHL患儿达CR;6例(50.0%)早期复发患儿达CR,7例(100.0%)晚期复发患儿均达CR,CR率明显高于早期复发患儿(P<0.05)。13例CR患儿,中位无病生存时间5.5个月(2～12个月)。血液学毒性Ⅳ级8例,Ⅲ级4例,Ⅱ级4例;合并感染13例(68.4%),均得到有效控制;肝脏毒性Ⅲ级1例,Ⅰ级2例,经治疗后均恢复。结论 FLAG方案治疗儿童复发性ALL及NHL疗效显著,尤其对于晚期复发患儿疗效较好;不良反应可以耐受。

Objective To evaluate the short-term efficacy and safety of FLAG regime for relapsed childhood acute lymphoblastic leukemia（ALL）and non-Hodgkin＇s lymphoma（NHL）.Methods Retrospective analysis of 19 patients with relapsed ALL and NHL patients,including 15 patients with ALL（8 cases of high risk,2 cases of mode-rate risk,5 cases of low risk）and 4 patients with NHL（stage IV）,was carried out.All patients were treated with FLAG regime[眼FLU 30 g/m2,d 1-5;Ara-c 2 g/m2,d 1-5;G-CSF 5 ug/（kg·d）].There were 12 early relapsed cases and 7 late-relapse cases.The efficacy,survival time and adverse events were recorded.Results After the first period of treatment,11（73.3%）patients with relapsed ALL achieved complete remission（CR）,including 5 cases of high risk,1 case of moderate risk,and 5 cases of low risk;2（50%）patients with relapsed NHL（clinical stage Ⅳ）achieved CR.Among 13 CR patients,6（50%）cases were early-relapse and 7（100%）cases were late-relapse.The rate of CR was obviously higher in late-relapse cases than that in early-relapse cases（P 0.05）.The disease free survival time of 13 CR patients was 2-12 months（median 5.5 months）.The hematological toxicity was detected,8 patients were grade Ⅳ,4 patients were grade Ⅲ,and 4 patients were gradeⅡ.Thirteen（68.4%）patients had a combined infection after chemotherapy and it had been effectively controlled.The hepatotoxicity was detected,including 1 case of grade Ⅲ and 2 cases of grade I and had recovered.Conclusions It is showed that FLAG regimen can effectively treatment relapsed childhood ALL and NHL,especially for the late relapsed patients.The adverse events could be well tolerated.