52例急性白血病患儿长期存活分析

Analysis of long-term survival of 52 children with acute leukemia

目的探讨儿童急性白血病长期存活的相关因素及临床意义。方法回顾性分析52例长期存活5年以上的急性白血病患儿的临床资料,总结分析可能影响长期存活的相关因素。结果 52例急性白血病患儿5年以上长期存活者中,29例为急性淋巴细胞白血病(ALL)患儿,其中27例第一疗程诱导化疗即达完全缓解(CR),4例行异基因造血干细胞移植(allo-HSCT),1例行自体造血干细胞移植(auto-HSCT);2例为急性混合细胞白血病(MAL),1例第一疗程CR,1例第二疗程CR;21例急性髓细胞白血病(AML),18例第一疗程CR,3例第二疗程CR,其中6例行allo-HSCT,1例行auto-HSCT。23例急性白血病患者发生中枢神经系统白血病(CNSL),应用阿糖胞苷、甲氨蝶呤(MTX)及地塞米松三联鞘内注射治疗后缓解。结论儿童白血病类型、发病年龄、发病时白细胞总数、第一疗程CR等是影响急性白血病患儿长期生存的重要因素;对难治性白血病患儿行造血干细胞移植(HSCT)可明显提高疗效。

Objective To explore the factors associated with long-term survival of children with acute leukemia and their significance.Methods Clinical data of 52 children with acute leukemia survived for more than 5 years were retrospectively analyzed.The possible factors associated with long-term survival were summarized and analyzed.Results Among 52 children with acute leukemia survived for more than 5 years,there were 29 children with acute lymphoblastic leukemia（ALL）[27 cases of complete remission（CR） during the first induction chemotherapy,4 cases of allogeneic hematopoietic stem cell transplantation（allo-HSCT） and one case of autologous hematopoietic stem cell transplantation（auto-HSCT）],2 children with mixed acute leukemia（MAL）（achieved CR during the first and the second course respectively） and 21 children with acute myeloid leukemia（AML）[18 cases of CR during the first course and 3 cases of CR during the second course which including 6 cases of allo-HSCT and a case of auto-HSCT].23 of 52 children with acute leukemia developed central nervous system leukemia（CNSL） and were remission after triple intrathecal chemotherapy comprising cytarabine,methotrexate（MTX） and dexamethason.Conclusion Childhood leukemia type,age of onset,total white blood cell count at onset,CR during the first course of chemotherapy are important factors which influence long-term survival of children with acute leukemia,and hematopoietic stem cell transplantation（HSCT） performed in children with refractory leukemia can significantly increase the therapeutic effect.