儿童白血病化疗后合并全身性真菌感染诊断及治疗体会

目的 积累和交流白血病化疗病人合并深部真菌感染时临床经验.方法 总结2年中明确诊断深部霉菌感染病人的诊断过程、方法、临床特征、治疗反应和转归.结果确诊深部真菌感染者共5例,均为白血病患儿,感染前或感染中白血病达完全缓解,特征性表现为发热,抗菌素治疗＞5天无效,轻中度压痛的多发性硬性皮下小结（2/5例）和肝脾肾散布性低密度病灶（3/5例）,需四周以上二性霉素治疗,有明显但可以处理的毒性反应.结论 发热、抗菌素治疗无效、硬性皮下小结和肝脾肾散布性低密度病灶时应考虑深部真菌感染,并给予4周以上二性霉素治疗.     

儿童白血病化疗后合并全身性真菌感染诊断及治疗体会

目的积累和交流白血病化疗病人合并深部真菌感染时临床经验。方法总结2年中明确诊断深部霉菌感染病人的诊断过程、方法、临床特征、治疗反应和转归。结果确诊深部真菌感染者共5例,均为白血病患儿,感染前或感染中白血病达完全缓解,特征性表现为发热,抗菌素治疗>5天无效,轻中度压痛的多发性硬性皮下小结(2/5例)和肝脾肾散布性低密度病灶(3/5例),需四周以上二性霉素治疗,有明显但可以处理的毒性反应。结论发热、抗菌素治疗无效、硬性皮下小结和肝脾肾散布性低密度病灶时应考虑深部真菌感染,并给予4周以上二性霉素治疗。     

儿童急性白血病化疗后合并侵袭性真菌病的临床分析

目的探讨儿童急性白血病化疗后合并侵袭性真菌病(IFD)的临床特征、诊断及预后。方法回顾性分析15例急性白血病化疗后合并IFD患儿的临床资料。结果 15例患儿中确诊4例,临床诊断8例,拟诊3例;感染部位,肺部8例,肝脏3例(其中1例合并脾脏真菌感染),鼻窦2例,真菌血症2例。均予抗真菌治疗,完全缓解4例,部分缓解2例,总有效率40.0%(6/15);稳定1例,疾病进展1例,总无效率13.3%(2/15)。死亡7例,病死率46.7%(7/15)。结论儿童急性白血病化疗后合并IFD以肺部真菌感染最常见,病原诊断困难,病情凶险,病死率高。     

儿童白血病化疗个体化的探讨

20世纪 4 0年代氮芥 (ＮＨ2 )和叶酸拮抗剂氨喋呤钠用于治疗恶性淋巴瘤和白血病获得短暂缓解 ,揭开了化疗的序幕 ,“经典”化疗已经历了半个多世纪 ,特别是近 2 0年已取得很大的长进 ,并获得可喜的成果 ,已能治愈 70 %～ 80 %的儿童急性淋巴细胞白血病和Ⅲ～Ⅳ期非霍奇金氏淋巴     

尼莫地平对儿童急性非淋巴细胞性白血病化疗增效的研究

急性非淋巴细胞性白血病 (ＡＮＬＬ)是一种严重危害儿童生命的疾病 ,尽管通过骨髓移植等有效的治疗可使患儿长期无病生存率达 6 0 %以上 ,但目前在国内仍然以联合化疗为主要治疗手段。采用柔红霉素 +阿糖胞苷 (ＤＡ)方案治疗2个疗程 ,其诱导缓解率为 70 %～ 80 % ,大约 2 0 %的患儿达不到完全缓解[1] 。为增强诱导期患儿的化疗效果 ,我们采用尼莫地平联合ＤＡ方案对曾单纯采用ＤＡ方案治疗 2疗程仍未达缓解的患儿进行治疗 ,取得了较满意的临床效果 ,现总结如下。对象和方法1 对象 :1995年 9月～ 2 0 0 0年 2月 ,我们采用尼莫地平联合ＤＡ方…     

急性白血病患儿发生突破性真菌感染的危险因素分析

目的 探讨急性白血病患儿化疗后发生突破性真菌感染(BIFI)的危险因素.方法 收集2015年1月-2020年8月在安徽医科大学第二附属医院儿童血液肿瘤科的急性白血病患儿的病例资料,其中28例并发BIFI患儿作为研究组,分别选取同时期、同性别、同疗程、同年龄段、同危险度92例未并发BIFI的患儿作为对照组,采用单因素分析...     

儿童急性淋巴细胞性白血病诱导化疗修正方案的近期临床评估

目的比较上海交通大学医学院附属上海儿童医学中心1999年开始使用的儿童急性淋巴细胞性白血病（ALL）治疗方案（以下简称99方案）,和在99方案基础上减轻治疗强度并从2005年开始使用的修正方案（以下简称05方案）诱导治疗的疗效、安全性,以提高儿童ALL的疗效。方法纵向对比1999年1月1日至2006年3月1日初治的311例ALL患儿临床资料;以2005年5月1日为分界线分为99方案组和05方案组。99方案组243例,05方案组68例。对两组患儿起病时临床资料、治疗反应、缓解情况、治疗相关的感染情况等进行统计分析。结果两组病例起病时各项临床资料（性别、年龄、诊断时外周血白细胞计数）差异均无统计学意义（P均〉0．05）,两组的缓解率（91．8％弧95．6％,P=0．29）和缓解时微小残留病（MRD）监测结果（P=0．17）差异也无统计学意义,99方案组与05方案组达到缓解所需时间（34．18±4．96d vs．32．34±3．36d）、治疗相关的感染率（54．7％伽．23．5％）、重症感染的发生率（9．1％vs.0）和病死率（3．7％vs.0）差异均有统计学意义。结论05方案和99方案在儿童ALL的诱导缓解治疗上都能取得良好的疗效,而05方案在疗效确切的同时具有更高的安全性。     

儿童急性淋巴细胞白血病诱导化疗费用及成本效果分析

对儿童急性淋巴细胞白血病诱导化疗的成本及成本效果进行分析，探讨经济有效的治疗方法及降低成本的方法，对34例急淋白血病患儿诱导化疗的两种方案进行回顾性分析评价，用成本效果分析的药物经济学方法进行比较。结果显示：两种化疗方案的成本费用、费用构成比、副作用发生率无统计学差异，与住院总费用相关最密切的前三位费用为药费、输血费、检查费，VDLP1持续完全缓解率为66．67％，VDLP2持续完全缓解率为81．25％，VDLP2成本低但效果好。因此，药物经济学可为临床合理用药，优选治疗方案提供参考，使有限的卫生资源发挥更大的社会效益。     

儿童急性白血病强化疗期间感染防治措施

目的：探讨儿童白血病强化疗期间感染防治措施。方法：对15例112例次儿童急性白血病强化疗期间76例次感染进行分析,并进行统计学处理。结果：外周血白细胞(WBC)4.0×109/L两组间感染率比较,具有显著性差异(P<0.01)。在外周血(WBC)<1.5×109/L,中性粒细胞绝对计数(ANC)<0.5×109/L时,加用粒细胞集落刺激因子(G-CSF),使WBC达到 4.0×109/L,ANC达到 1.5×109/L所需平均天数与未加用G-CSF组比较,两组均数进行t检验,P<0.01。使用静脉丙种球蛋白(IVIG)者发热持续时间与未使用IVIG组比较,两组均数进行t检验,P<0.01。结论：感染与白细胞降低有明确关系,通过使用广谱抗生素、G-CSF及IVIG可使感染得到较好控制。     

Adrenal axis function after high-dose steroid therapy for childhood acute lymphoblastic leukemia

Background A 4‐week course of high‐dose glucocorticoids may cause prolonged adrenal suppression even after a 9‐day tapering phase. In this study, adrenal function and signs and symptoms of adrenal insufficiency were prospectively assessed in children with acute lymphoblastic leukemia (ALL) after induction treatment including high‐dose prednisone (PDN) or dexamethasone (DXM). Procedures Sixty‐four children with ALL, treated according to the AIEOP ALL 2000 Study protocol, underwent low dose ACTH (LD‐ACTH) stimulation 24 hr after the last tapered steroid dose. In those with impaired cortisol response, additional LD ACTH tests were performed every 1–2 weeks until cortisol levels normalized. Signs and symptoms of adrenal insufficiency were recorded during the observation period. Results All patients had normal basal cortisol values at diagnosis. Twenty‐four hours after last glucocorticoid dose, morning cortisol was reduced in 40/64 (62.5%) patients. LD‐ACTH testing showed adrenal suppression in 52/64 (81.5%) patients. At the following ACTH test 7–14 days later, morning cortisol values were reduced in 8/52 (15.4%) patients and response to the test was impaired in 12/52 (23%). Adrenal function completely recovered in all patients within 10 weeks. No difference was found between patients treated with PDN or DXM. Almost 35% of children with impaired cortisol values at the first test developed signs or symptoms of adrenal insufficiency. One child developed a severe adrenal crisis during adrenal suppression. Conclusions High‐dose glucocorticoid therapy in ALL children may cause prolonged adrenal suppression and related clinical symptoms. Laboratory monitoring of cortisol levels and steroid coverage during stress episodes may be indicated. Pediatr Blood Cancer 2008;50:537–541. © 2007 Wiley‐Liss, Inc.     

儿童急性白血病继发丙型病毒性肝炎

目的 探讨儿童急性白血病继发输血后丙型病毒性肝炎的发生、发展及转归。方法 用ＲＴ－ＰＣＲ法检测血清ＨＣＶ－ＲＮＡ,并用ＥＬＩＳＡ方法测ＨＣＶ核心区多肽抗体（ＨＣＶ－ＣＰ）。结果 １０７例儿童白血病中ＨＣＶ感染率达７０％（７５／１０７）;ＨＣＶ－ＣＰ检测阳性率明显低于ＨＣＶ－ＲＮＡ（４０％ｖｓ７４％）;ＨＣＶ感染者化疗期间曾有转氨酶（ＡＬＴ）明显升高,但停止化疗后５０例中仅１例ＡＬＴ持续偏高,余均恢     

Double invasive fungal infection and typhlitis in children with acute lymphoblastic leukemia

Invasive fungal infection is one of the major causes of morbidity and mortality in immunocompromised patients. The occurrence of two invasive fungal infections in one patient at the same time is quite rare. Here the authors report on two adolescent patients with acute lymphoblastic leukemia who developed combined invasive pulmonary aspergillosis and hepatosplenic candidiasis during chemotherapy. They were treated with liposomal amphotericin B, but one of them died due to massive pulmonary hemorrhage during recovery from neutropenia.     

儿童急性白血病合并中枢神经系统真菌感染5例并文献复习

目的通过5例儿童急性白血病合并中枢神经系统(CNS)真菌感染的临床总结及相关文献复习,提高对本病的认识。方法回顾性分析北京儿童医院收治的5例急性白血病合并CNS真菌感染患儿的临床特点及诊治经过并文献复习。结果(1)4例急性淋巴细胞白血病(ALL)患儿均接受强化疗,1例为急性非淋巴细胞白血病(AML-M2)半相合造血干细胞移植术后,发生CNS真菌感染前均有肺部真菌感染病史,其中2例合并肝、脾、肾真菌感染,1例合并下肢皮肤真菌感染(2)实验室检查3例有病原学依据,1例烟曲霉菌,2例念珠菌,2例无病原学依据。(3)影像学5例患儿均作头颅CTMRI,表现脓肿、梗塞、颅内出血。(4)治疗及预后1例患儿伊曲康唑+脂溶性两性霉素B治疗,2例患儿伏立康唑治疗,2例患儿伏立康唑和两性霉素B联合抗真菌治疗,抗真菌治疗均有效,4例存活,1例死于严重移植物抗宿主病(GVHD)。结论儿童急性白血病合并CNS真菌感染为侵袭性真菌感染的表现形式之一,多半有其他脏器感染,临床表现不典型,可有脑膜炎或脑脓肿症状和体征,诊断困难,CT、MRI影像学检查重要,伏立康唑、两性霉素B抗真菌治疗有效。     

Repeated use of L-asparaginase in multi-drug therapy of childhood leukemia

The capacity of l-asparaginase in two separate schedules (consecutive and intermittent), along with vincristine and prednisone to produce multiple responses, was evaluated in previously treated children with acute leukemia in relapse. The response rates varied inversely with previous l-asparaginase exposure. A history of prior resistance to prednisone and vincristine appeared to reduce the response rate. Hypersensitivity reactions occurred in 14%.     

Evaluation of dose and schedule of L-asparaginase in multidrug therapy of childhood leukemia

Six regimens utilizing L-asparaginase in doses of 6,000 IU/M², 2,000 IU/M², and 500 IU/M² in two separate schedules (consecutive and intermittent) along with vincristine and prednisone yielded remarkably similar response rates, approximating 70%, in 306 previously treated children with acute leukemia in relapse. The addition of daunorubicin to one regimen did not alter the response rate. Hypersensitivity reactions occurred in 5% and hyperglycemia in 7%. Lower doses of L-asparaginase significantly reduced the hypersensitivity rate but no such pattern was noted for hyperglycemia. A history of prior resistance to prednisone and vincristine significantly reduced the response rate.