儿童高白细胞白血病的临床特点及疗效

Clinical Characteristics and Treatment of Hyperleukocytic Leukemia in Children

目的:探讨儿童高白细胞白血病(HLL)的临床特点及治疗效果。方法:收集38例HLL患儿资料,根据免疫分型将患儿分为淋巴细胞白血病组和髓细胞白血病组,比较两组患儿部分血液学指标及临床特征,观察治疗结果。结果:38例HLL患儿中急性淋巴细胞白血病23例、急性髓细胞白血病10例、慢性髓细胞白血病5例,HLL患儿除高白细胞外,均存在不同程度的贫血及血小板减少,淋巴细胞白血病组患儿血小板水平低于髓细胞白血病组患儿(P <0. 05); HLL患儿肝脾淋巴结肿大、发热、皮肤出血等发生率高,淋巴细胞白血病组患儿遗传学改变发生率显著低于髓细胞白血病组患儿(P <0. 05); 38例HLL患儿中23例自请出院、电话随访均死亡,14例接受治疗(2例患儿完成所有化疗、目前缓解状态,5例仍持续口服伊马替尼,1例化疗期返家失访、6例患儿于化疗期严重感染死亡)。结论:HLL患儿脏器浸润严重,预后差,治疗效果较差,髓细胞白血病较淋巴细胞白血病更易发生遗传学改变。

Objective:To investigate the clinical characteristics and treatment of children with high leukocyte leukemia(HLL).Methods:From October 2011 to July 2015,38 cases of hyperleukocytic leukemia of children treated in our hospital were divided into lymphocytic leukemia group and myeloid leukemia group according to immune classification and some hematological indexes and clinical characteristics of the two groups were compared to analyze the treatment results.Results:Of the 38 children with HLL,23 cases had acute lymphocytic leukemia,10 cases had acute myeloid leukemia,and 5 cases had chronic myeloid leukemia.In addition to high white blood cell count,all the children with HLL had anemia and thrombocytopenia to different degrees.PLT level in the lymphocytic leukemia group was lower than that in the myeloid leukemia group(P<0.05).The incidence of hepatosplenic lymph node enlargement,fever and skin bleeding was high in children with HLL,and the incidence of genetic changes in children with lymphocytic leukemia was significantly lower than that in children with myeloid leukemia(P<0.05).Among the 38 children with HLL,23 died after self-discharge by telephone follow-up,and 14 received treatment(2 children were done all chemotherapy and in remission,5 of them still continued to take imatinib orally,1 of them returned home and lost follow-up during chemotherapy,and 6 children died of severe infection during chemotherapy).Conclusion:Myeloid leukemia in children with HLL is more prone to genetic changes than lymphocytic leukemia;HLL is an acute disease of leukemia with severe visceral infiltration,high early-stage mortality,poor prognosis,low remission rate and high recurrence rate.The main treatment regimen is comprehensive prevention and treatment,which can reduce the early-stage mortality rate,strive for the opportunity of chemotherapy,and improve the prognosis.