甲磺酸伊马替尼联合VDLD方案诱导治疗儿童急性淋巴细胞白血病的临床观察

Clinical Observation of Inductive Treatment of Childhood Acute Lymphoblastic Leukemia with Imatinib Mesylate Combined with VDLD Regimen

目的 探讨甲磺酸伊马替尼联合长春地辛+地塞米松+培门冬酶+去甲氧柔红霉素方案(VDLD方案)诱导治疗儿童急性淋巴细胞白血病(acute lymphoblastic leukemia, ALL)的临床价值。方法 选取我院收治的BCR与ABL融合蛋白阳性的94例ALL患儿作为研究对象,根据不同治疗方案分为对照组( n = 40)和观察组( n =54)。两组均予VDLD方案及常规治疗,在此基础上,观察组加用甲磺酸伊马替尼。两组均治疗60 d。比较出院后3个月的近期临床疗效,分析出院后1年、3年、5年的预后生存情况,记录不良反应发生情况。结果 观察组、对照组近期临床总有效率分别为92.59%、77.50%,比较差异有统计学意义(χ^2= 4.392、 P =0.036)。观察组、对照组出院后5年总生存率分别为88.89%、70.00%,无复发生存率分别为74.07%、50.00%,比较差异均有统计学意义( P <0.05)。观察组、对照组不良反应总发生率分别为33.33%、27.50%,比较差异无统计学意义(χ^ 2=0.367、 P =0.545),且均未出现肝损害和神经毒性等明显严重不良反应。两组不良反应均予相应治疗后症状明显缓解或消失。结论 甲磺酸伊马替尼联合VDLD方案治疗ALL患儿可显著提高近期临床疗效和远期预后,且具有一定的安全性,可作为临床治疗ALL患儿的首选方案。

Objective To investigate the clinical value of imatinib mesylate combined with vindesine, dexamethasone, pegaspargase and idarubicin (VDLD regimen) in the inductive treatment of childhood acute lymphoblastic leukemia (ALL). Methods A total of 94 children with ALL who were positive for BCR and ABL fusion protein in our hospital were selected as subjects. According to different treatment programs they were divided into control group ( n =40) and observation group ( n =54). Both groups were given VDLD regimen and conventional treatment. On this basis, the observation group was supplemented with imatinib mesylate. Both groups were treated for 60 d. The short-term clinical efficacy was compared at 3 months after discharge. The 1, 3, and 5-year prognosis after discharge was analyzed, and the incidence of adverse reactions was recorded. Results The total effective rate of the observation group and the control group was 92.59% and 77.50% respectively, and the difference was statistically significant (χ^ 2=4.392, P =0.036). The 5-year overall survival rate of the observation group and the control group after discharge was 88.89% and 70.00%, respectively. Recurrence-free survival rates were 74.07% and 50.00%, respectively, and the difference was statistically significant ( P <0.05). The total incidence of adverse reactions in the observation group and the control group were 33.33% and 27.50%, respectively, and there was no significant difference between the observation group and the control group (χ^2=0.367, P =0.545). There were no obvious serious adverse reactions such as liver damage and neurotoxicity. Adverse reactions were significantly alleviated or disappeared after corresponding symptomatic treatment. Conclusion In the treatment of children with ALL, imatinib mesylate combined with VDLD regimen can significantly improve the short-term clinical efficacy and long-term prognosis, and it has a certain degree of safety. Therefore, it is worthy of being the first-choice treatment plan for children with ALL in clinical practice.