儿童急性髓系白血病163例临床分析

Clinical observation of 163 childhood with novo acute myeloid leukemia

目的分析重庆医科大学附属儿童医院初诊急性髓系白血病（AML）患儿的临床资料，为进一步完善治疗方案提供依据。方法除外急性早幼粒细胞白血病，2008年1月-2012年12月共收治AML患儿163例，分析其临床资料。结果（1）以男性和5～10岁组患儿较多见；中位初诊年龄为5岁4个月，其中有18例患儿初诊年龄≤1岁。（2）骨髓MICM分型检查：FAB分型中以M2亚型最多见；免疫分型除139例患儿单纯表达髓系分化抗原表达以外，21例同时伴有淋巴系抗原表达，3例为未表型；细胞遗传学中异常核型的检出率为66％，以复杂核型最多见；26例患儿检测到AML1-ETO融合基因。（3）本研究治疗率55．2％，总诱导缓解率为87．8％，无诱导缓解化疗相关死亡患儿。（4）90例接受诱导缓解化疗患儿中位生存时间为13个月，中位无复发生存时间为9个月，其中43例接受2个疗程以上根治性缓解后化疗患儿中位生存时间为20个月，中位无复发生存时间为14个月。结论我院AML患儿治疗率仅为52．5％。还需要进一步完善AML患儿临床危险度分组以指导治疗，以中大剂量阿糖胞苷为主的化疗可改善预后。

Objective Analysis the clinical characteristics and treatment results of novo childhood AML in Children＇s Hospital of Chongqing Medical University to improve treatment protocol. Methods 163 novo AML patients were enrolled in the study from January 2008 to December 2012, except APL. Results 1. Male and patients aged 5 to 10 years old were much more; the median age was 5years and 4 months, among them there were 18 patients aged ≤ 1 years old. 2. MICM types： M2 was the most common FAB type; part of the patients also has lymphatic antigens; there were 66% of all the patients have abnormal karyotype, in which complex karyotype accounted the most; 26 patients checked out AML1 - ETO fusion gene. 3. The treatment rate was only 55.2% , CR rate was 87.8% , none patients died from treatment related diease. 4. The medial survival time was 13 months and medial none relapsed survival time was 9 months for the 90 patients accepted induction chemotherapy. While the medial survival time was 20 months and medial none relapsed survival time was 14 months for the 43 patients accepted more than 2 courses of consolidation chemotherapy. Conclusions Medium - dose cytarabine chemotherapy improved curative effect, still need perfect risk - direct treatment protocol.