氯法拉滨治疗儿童复发/难治性急性淋巴细胞性白血病的疗效分析

目的：探讨氯法拉滨应用于儿童复发/难治性急性淋巴细胞性白血病的疗效和不良反应。方法：26例复发/难治性急性淋巴细胞性白血病患儿接受氯法拉滨单药治疗，男22例，女4例，中位年龄9.5岁（4~17岁）。患儿均接受连续5 d静脉滴注氯法拉滨（52 mg/m2，每次超过2 h），其中13例患儿接受连续2次氯法拉滨单药化疗，1例患儿接受连续3次氯法拉滨单药化疗。结果：26例患儿第1次氯法拉滨化疗后11例（42%）获完全缓解，7例（27%）获部分缓解，总有效率69%，8例（31%）未缓解。26例患儿中，13例继续给予第2次氯法拉滨化疗后11例（85%）获完全缓解，1例（8%）部分缓解，1例（8%）未缓解。其中1例患儿接受3次氯法拉滨化疗均获完全缓解。化疗的不良反应主要为中性粒细胞减少、感染、肝功能损害、胃肠道反应，无化疗相关死亡病例。结论：氯法拉滨治疗儿童复发/难治性急性淋巴细胞性白血病有一定疗效，不良反应可以耐受，是一种新的治疗选择。

Therapeutic effect of clofarabine in children with relapsed or refractory acute lymphoblastic leukemia

Objective To explore the efficacy and adverse effects of clofarabine for relapsed/refractory acute lymphoblastic leukemia in children.Methods Twenty-six pediatric patients with relapsed/refractory acute lymphoblastic leukemia were treated with clofarabine.There were 22 males and 4 females,with a mean age of 9.5 years(ranging from 4 to 17 years).They received clofarabine 52 mg/m2 intravenously over 2 hours daily for 5 days.Thirteen patients received two cycles and one patient received three cycles.Results In the first cycle of clofarabine,complete remission was obtained in 11 children(42%) and partial remission was obtained in 7 children(27%).Eight children(31%) were considered unresponsive.In the second cycle,11(85%) of the 13 children obtained complete remission,1(8%) partial remission and 1(8%) was unresponsive.One child received three cycles and obtained complete remission in each cycle.The common adverse events were myelosuppression,infection,liver dysfunction and gastrointestinal adverse reactions.There were no chemotherapy-related deaths.Conclusions Clofarabine is effective in the treatment of children with relapsed/refractory acute lymphoblastic leukemia and its adverse effects can be tolerated.Clofarabine could be a promising new treatment for relapsed/refractory acute lymphoblastic leukemia.