影响小儿急非淋白血病化疗长期缓解的因素探讨

使用ＨＯＡＰ＋ＤＥＡ方案治疗小儿急性非淋巴细胞性白血病（ＡＮＬＬ）３６例。２１例（５８％）先后放弃治疗。１９例坚持治疗者，完全缓解（ＣＲ）１１例（５７％），持续完全缓解（ＣＣＲ）〉５年１例（５．３％），≥２年３例（１５．８％），〉１年者２例（１０．６％）。总结认为，影响小儿ＡＮＬＬＣＣＲ最主要取决于初治时化疗强度、ＣＲ后的治疗措施，及地区经济因素。     

小儿急淋白血病强化疗导致一个剂量即骨髓缓解的报告

近十几年来随着联合化疗的发展,小儿急性淋巴细胞性白血病(简称急淋)的完全缓解率及持续完全缓解率不断提高,5年无病生存率可达50～70%,但仍有相当部分病儿缓解后复发。为了探讨提高长期无病生存率的方法,我们于1989年10月设计了     

大剂量甲氨蝶呤治疗急淋白血病的副作用观察及对策

对接受大剂量甲氨蝶岭（MTX）治疗的急性淋巴细胞性白血病患儿，观察及总结MTX副作用的种类、发生率，评价相应防治MTX副作用措施的实用性及价值。方法病例来源：急淋患儿33例共接受大剂量MTX治疗107例次，以临床症状、体征、实验室检查为观察指标，总结MTX的副作用发生种类及发生率；采用还原型谷胱甘肽（TAD）护肝治疗及大剂量Vit B12肌注为主的综合防治措施分别防治MTX对肝脏和粘膜的毒副作用，对比采用防治措施前后毒副作用的发生率及程度的变化，结果进行统计学处理（t检验），评价其防治效果。结论33例患儿接受MTX冲击治疗后副作用的发生率及种类与国外报道基本一致，两种综合防治措施是有效的，值得推广；甲基强的松龙治疗MTX引起的剥脱性皮炎的方法能否推广应用尚需进一步观察。     

重视儿童白血病化疗规律为提高长期持续缓解率而努力

重视儿童白血病化疗规律为提高长期持续缓解率而努力赵新民近二十年来，分子生物学、免疫学、细胞遗传学和骨髓体外培养等技术的进步，加深了我们对儿童急性白血病的理解和认识。强化化疗、异基因骨髓移植以及全身支持治疗的加强已使急性白血病的治疗效果得到显著改善。特...     

小儿急性淋巴细胞白血病细胞形态特征与诱导化疗反应性的关系研究

本文观察了２８例小儿急性淋巴细胞性白血病（ＡＬＬ）患儿细胞形态特征与诱导化疗反应性间的关系。原幼淋巴细胞特征的主要观察项目为胞浆空泡、核仁及凋亡细胞。根据临床分型（标危型和高危型）分别应用ＤＯＰ或ＤＯＡＰ诱导化疗，上述方案无效者改用ＶＰ１６、大剂量ＭＴＸ等有效的药物。结果提示：２１例空泡计分≥１５，在治疗较短时间内（２０．８％）获完全缓解（ＣＲ），而空泡计分〈１５的７例诱导ＣＲ时间显著延长（５９．     

小儿非高危急淋白血病降低化疗强度的经济诊治方案的说明

在杭州举行的2005年全国小儿血液/肿瘤学术会议上,提出了小儿非高危急性淋巴细胞白血病降低化疗强度的经济诊治方案,此方案已在本刊2005年第6期刊登,现就其背景及与其他降低化疗强度方案做一比较.     

大剂量甲氨蝶呤治疗急淋白血病的副作用观察及对策

对接受大剂量甲氨蝶岭 (MTX)治疗的急性淋巴细胞性白血病患儿 ,观察及总结MTX副作用的种类、发生率 ,评价相应防治MTX副作用措施的实用性及价值。方法病例来源 :急淋患儿 33例共接受大剂量MTX治疗 1 0 7例次 ,以临床症状、体征、实验室检查为观察指标 ,总结MTX的副作用发生种类及发生率 ;采用还原型谷胱甘肽 (TAD)护肝治疗及大剂量VitB12 肌注为主的综合防治措施分别防治MTX对肝脏和粘膜的毒副作用 ,对比采用防治措施前后毒副作用的发生率及程度的变化 ,结果进行统计学处理 (t检验 ) ,评价其防治效果。结论 33例患儿接受MTX冲击治疗后副作用的发生率及种类与国外报道基本一致 ,两种综合防治措施是有效的 ,值得推广 ;甲基强的松龙治疗MTX引起的剥脱性皮炎的方法能否推广应用尚需进一步观察。     

rhG-CSF在小儿ANLL强烈化疗中的应用

为探讨rhG-CSF对小儿ANLL强烈化疗后粒细胞缺乏的疗效，采用AAE方案（ADM、Ara-C、VP(16)或VM(26)），化疗后当WBC＜1×109/L或ANC＜0．5×109/L时，给予rhG-CSF200μg/m2·d（5～10μg/kg·d），皮下注射，一般连续5～10天。本文15例ANLL，用rhG-CSF30例次。用rhG-CSF前，WBC平均0．78×109/L、ANC0．15×109/L。用rhG-CSF后，平均6．5天WBC升至＞3×109/L、ANC升至＞1×109/L。粒细胞恢复时间与对照组相比明显缩短（P＜0．01）。骨髓复查未见原始细胞增多或复发。rhG-CSF有促进强烈化疗所致骨髓抑制和粒细胞缺乏的恢复，但未见骨髓原始细胞增多和白血病复发。     

联合化疗对急性白血病患儿脑脊液中三种激素水平的影响

随着联合化疗的进展，小儿急性白血病长期存活人数增多，化疗的副作用特别是对儿童生长的影响也逐渐引起了人们的关注（1）。联合化疗对儿童生长发育的影响可能是多方面的，但对激素的影响如何未见详细报道，我们对此进行了初步研究。对象和方法一、对象急性白血病患儿21例，男16例，女5例，年龄2卞～13岁，中位数65岁。其中急性淋巴细胞白血病17例，急性非淋巴细胞白血病4例。联合化疗根据细胞类型决定联合化疗方案（急淋应用DOAP方案，急非淋用HOAP方案）。对照组15例，为非颅内疾病患儿，年龄2～12岁，中位数712岁，其中男性9例，女6…     

CEREBROSPINAL FLUID OXIDATIVE STRESS DURING CHEMOTHERAPY OF ACUTE LYMPHOBLASTIC LEUKEMIA IN CHILDREN

In this study the authors addressed the question whether neurotoxicity due to the chemotherapy of acute lymphoblastic leukemia (ALL) is associated with cerebrospinal fluid (CSF) oxidative stress. Examination of 38 ALL patients revealed significant increases in 8-isoprostane concentration and important decreases in total antioxidative capacity of CSF during therapy. The mean 8-isoprostane level at diagnosis was 9.05 ± 1.62 pg/mL, and no correlations with initial leukocytosis, organomegaly, and lactate dehydrogenase levels were noted. 8-Isoprostane concentrations were increased on the 59th day of treatment (mean level: 24.85 ± 7.59 pg/mL [P < .01]) and remained elevated at 4 points of the consolidation phase (17.28 ± 2.16 pg/mL [P < .05]; 22.72 ± 6.04 pg/mL [P < .05]; 24.92 ± 6.31 pg/mL [P < .01]; 32.32 ± 7.94 pg/mL [P < .01]) as compared to their level at diagnosis. The mean total antioxidative capacity at diagnosis was 203.08 ± 6.17 μmol/L and was remarkably decreased on the 59th day of treatment (189.76 ± 1.9 μmol/L [P < .05]) and at one point of the consolidation phase (188.29 ± 3.46 μmol/L [P < .05]) as compared to the level at diagnosis. This study indicates that neurotoxicity of standard ALL treatment may be related to oxidative stress.     

LONG-TERM EFFECTS OF CHEMOTHERAPY ON DENTAL STATUS IN CHILDREN TREATED FOR NEPHROBLASTOMA

Dental abnormalities among children treated at a young age for Wilms tumor are reported. The authors retrospectively reviewed the dental records and panoramic radiographs of 27 children treated for nephroblastoma between 1994 and 1998. They evaluated the frequency of apparent microdontia, excessive caries, root stunting, hypodontia, and enamel hypoplasia and compared this group to a control group of 78 children. Seventy percent of the children developed dental abnormalities, comprising root stunting (44%), enamel hypoplasia (22%), microdontia (18%), and hypodontia (7%). Results of control subjects were significantly different regarding dental abnormalities, especially microdontia and taurodontia. These results indicate that chemotherapy in children may lead to troubles affecting teeth growing at the time of treatment. Information and prospective dental care are needed, and further investigations are required.     

高频度强化治疗儿童ALL远期疗效报道

为了提高ＡＬＬ的最终疗效,我们使用高频度强化治疗了我科收治的５例在经济上有能力承受的初治ＡＬＬ病人。方法：第一个化疗年内每个月一次强化治疗;第二化疗年每两个月一次强化治疗;第三个化疗年内每三个月一次强化治疗;第四个化疗年内每四个月一次强化治疗;第五个化疗年内半年一次强化治疗。强化化疗方案以ＣＯＤＰ（Ｌ）、ＣＯＡＰ、Ｖｍ２６＋ＡＲＡ－Ｃ、ＨＤＭＴＸ、ＡＲＡ－Ｃ＋Ｖｍ２６＋Ｃａｒｂｏ＋ＣＴＸ为主。结果：３例病人停药两年和１例停药一年以上,获得长期无病生存;两例髓外复发后骨髓复发,经再诱导化疗获完全缓解。总结：我们的结果表明：高频度强化治疗对获得ＬＴＤＦＳ是有益的,并没有导致耐药性的产生;疗程的缩短（２－３年）并没有影响疗效;本组病例数欠少,进一步扩大试验是必须的。     

小儿急性白血病外周血NK细胞的变化

本文对20例小儿急性白血病进行了外用血NK细胞活性的测定。男13例、女7例，年龄4～13岁。其中急淋5例、急非淋15例。结果表明：急性白血病患儿NK细胞活性明显下降，与对照组（正常健康儿男12、女15，年龄为5～13岁）相比有显著差异，P＜0.05，并与文献报道相符。文中指出，在白血病的治疗过程中从其缓解、复发时NK细胞活性变化的检测，有益于对病情的了解、感染的存在等估评。例数偏少有待进一步阐明。     

急性淋巴细胞性白血病患儿脑脊液腺苷脱氨酶活性的测定

为了探讨脑脊液腺苷脱氨酶（ADA）对中枢神经系统白血病（CNSL）的诊断价值，用比色法对7例急性淋巴细胞性白血病（ALL）伴CNSL和14例无CNSL的ALL患儿进行了脑脊液ADA活性的测定并与15例对照儿的测定值比较。结果，无CNSL的ALL患儿的测定值与对照组比较无明显差别（P＞0．05），而伴CNSL的ALL患儿的测定值明显高于无CNSL的ALL患儿和对照儿的测定值（P＜O．05），并随治疗的好转而明显下降，提示脑脊液ADA活性的测定有助于CNSL的诊断及疗效观察。     

NEUROPSYCHOLOGIC SEQUELAE IN THE LONG-TERM SURVIVORS OF CHILDHOOD ACUTE LYMPHOBLASTIC LEUKEMIA

The neurotoxicity of either systemic chemotherapy or central nervous system prophylaxis was studied in 19 children treated for acute lymphoblastic leukemia (ALL). They had completed ALL therapy at least a year before and survived more than 5 years after diagnosis. The duration between age at diagnosis and age at investigation was 8.6 2.7 years (5-15 years). Neuropsychologic tests, cranial magnetic resonance imaging (MRI), and evoked potentials (EP) were studied. Seventeen healthy siblings were taken as a control group. Emotional evaluation was done using the childhood depression inventory and Beck depression inventory. Cognitive functions were evaluated using Wechsler's Intelligence Scale for Children-Revised (WISC-R) or the Wechsler's Adult Intelligence Scale-Revised (WAIS-R) tests, which were adapted to Turkish children. Performance and total IQ scores (94.0 16.8 and 92.2 16.5) were significantly low as compared to the control group (112.1 18.9 and 105.4 14.2) (p=.007 and p=.02). Abnormal MRI findings were found in 33.3% (6/18). Three out of 18 patients (16.6%) had abnormal auditory while 5 out of 17 patients (29.5%) displayed abnormal visual EPs. Abnormal findings in MRI, cognitive examination, and electrophysiologic testing were not associated with age at diagnosis, radiotherapy doses, intermediate/high-dose systemic methotrexate administration or central nervous system involvement. But more patients must be studied to demonstrate discrete outcomes of neurotoxicity in long-term survivors of childhood leukemia.     

小儿急性白血病血清NO_2/NO_3和cGMP的变化

研究小儿性白血病血清NO_2／NO_3和cGMP的变化及其临床意义，为本文研究目的。应用镀铜镉还原法和放射免疫法检测患儿血清中NO的代谢产物NO_2／NO_3和cGMP含量。结果表明：小儿急性白血病急性期血清NO_2／NO_3和cGMP的含量明显高于正常对照组和完全缓解期组（P＜0．01）；急性淋巴细胞白血病与急性非淋巴细胞白血病相比无显著性差异（P＞0．05）。完全缓解期组与正常对照组相比，无显著性差异（P＞0．05）。结论：血清NO的检测可用于判断小儿急性白血的病情和监测化疗效果的指标之一，揭示了临床选用NO的细胞毒性作用可能为小儿急性白血病的治疗提供新的方法。