氟达拉滨联合阿糖胞苷及粒细胞集落刺激因子治疗儿童难治及复发性急性白血病

Clinical observation of fiudarabine, cytarabine and granulocytecolony-stimulating factor regime in the treatment of children with refractory and relapsed acute leukemia

目的观察氟达拉滨（Flud）联合阿糖胞苷（Ara-C）及粒细胞集落刺激因子（G-CSF）（FLAG）方案治疗儿童难治及复发性急性白血病（AL）的疗效及患者不良反应。方法9例复发及难治性AL患儿接受了FLAG方案治疗，Flud每天30mg／m^2，第1天至第5天，静脉滴注30min；Ara．C每天2g／m2，Flud应用后4h静脉滴注，第1天至第5天。G-CSF5μg·kg^-1·d^-1，中性粒细胞〈0．5×10^9／L时开始应用，用至中性粒细胞≥1×10^9／L。9例患儿中急性髓系白血病（AML）8例，急性淋巴细胞白血病（ALL）1例；难治性AL5例，复发性AL4例。结果9例患儿中经1个疗程化疗达完全缓解（CR）6例，部分缓解（PR）2例，总有效（CR＋PR）率88．9％（8／9）。6例CR患者中2例行造血干细胞移植，现均无瘤生存；患者主要不良反应是感染、骨髓抑制和胃肠道反应。结论FLAG方案治疗儿童难治及复发性AL缓解率高，不良反应可以耐受，是治疗儿童难治及复发性AL的一个选择，为后续的造血干细胞移植提供了机会。

Objective To observe the clinical efficacy and adverse reaction of the combination of fiudarabine, cytarabine and granulocytecolony-stimulating factor （G-CSF） （FLAG regime） therapy for refractory and relapsed acute leukemia in children. Methods From 2004 to date, a total of 9 patients with relapsed and refractory acute leukemia patients in our hospital accepted the treatment, in 9 cases 8 cases were AML, lcases were ALL; in 9 cases 5 cases were refractory acute leukemia, 4 cases were recurrent acute leukemia. Results Among the 9 cases, 6 cases with 1 cycles of chemotherapy achieved complete remission （CR）, CR rate was 66.7 % （6/9）; partial remission （PR） rate was 22.2 % （2/9）, total efficiency （CR＋PR） was 88.9 %. In 6 CR patients 2 underwent hematopoietic stem cell transplantation, are disease-free survival; this regimen＂ s main adverse reactions were infection, bone marrow depression and gastrointestinal reaction. Conclusion The remission rate of FLAG regimen in the treatment of children with refractory and relapsed acute leukemia is relatively high, adverse reactions were tolerable; the FLAG program is a choice for the treatment of children with refractory and relapsed acute leukemia, which provides the opportunity for subsequent hematopoietic stem cell transplantation.