儿童急性淋巴细胞性白血病并发中枢神经系统白血病的临床治疗研究

Intermittent central nervous system irradiation as a supplement to chemo-radiotherapy for acute lymphocyic lenkemia in children

目的 :探讨儿童中枢神经系统白血病复发再治疗的安全有效方法。方法 :应用国产 60Co ,对 2 7例曾接受全颅、全脊髓放射治疗和 (或 )鞘内注射后CNSL复发的儿童急性淋巴细胞性白血病进行全颅、全脊髓间歇性放射治疗 ,并联合鞘内注射。治疗方案为 :全颅 1 5Gy/次 +全脊髓 0 75Gy/次 ,1次 /d照射 3d。第 1天鞘内注射甲氨蝶呤 (MTX ) 8～ 12mg/m2 ,阿糖胞苷 (Ara C) 2 5mg/m2 ,地塞米松 (DXM ) 2～ 5mg/次 ,以后每 8周全颅1 5Gy +全脊髓 0 75Gy照射 1次 ,当天鞘内注射 ,用药剂量同前。总疗程为 2年2个月。结果 :2 7例患者中 ,3年内死于骨髓复发 4例、CNSL复发 2例 ;3～ 5年内死于骨髓复发 5例、CNSL复发 8例 ,3、5年生存率分别为 77 8% (2 1/2 7)、2 5 9%(7/2 7)。间歇性放射治疗过程中未发现明显急性毒副反应。随访期间发现 5例记忆力差、注意力不易集中现象。结论 :间歇性放射治疗联合鞘内注药对于曾接受全中枢神经系统放射治疗和 (或 )鞘内注射后CNSL复发的儿童急性淋巴细胞性白血病安全而有效。

OBJECTIVE:To explore the retreatment for the recurrent leukemia of central nervous system in children.METHODS:Twenty seven children with central nervous system leukemia (CNSL)relapse who had had total CNS irradiation or intrathecal injection were treated with combined intermittent CNS irradiation and intrathecal chemotherapy.For radiotherapy, 60 Co accelerator was used to deliver 1 5 Gy to whole craniumbrain and 0 75 Gy to the whole spinal column,QD×3.For intrathecal chemotherapy,MTX 8 12 mg/m 2 ,Ara C 25 mg/m 2 and DXM 2 5 mg were injected intrathecally on D1.Then one whole skull irradiation of 1 5 Gy and whole spinal column irradiation of 0 75 Gy plus 1 intrathecal injection treatment was given in one day once every eight weeks to a total course of two years and two months.RESULTS:Among the 27 patients,4 died of bone marrow relapse and 2 died of CNS relapse within 3 years. Between 3 and 5 years after treatment,the numbers of the death of bone marrow relapse or CNS relapse were 5 and 8 respectively.The 3 year and 5 year survival rates were 77 8%(21/27) and 25 9%(7/27) respectively.No acute toxicity was found during the intermittent craniospinal irradiation.There were 5 patients experienced poor memory and poor attention during the follow up time.CONCLUSIONS:Intermittent craniospinal irradiation combined with intrathecal chemotherapy is a safe and effective salvage therapy for children with acute lymphocytic leukemia when relapse after craniospinal irradiation and/or intrathecal chemotherapy.