生存五年以上死亡急性白血病17例报告

目的:探讨急性白血病(AL)生存五年以上死亡原因。方法:采用回顾性系列研究,统计本院生存五年以上死亡急性白血病患儿的发病年龄、性别、化疗前病程、分型、病史、临床表现、血常规、骨髓象、并发症、微小残留病灶检测(MRD)、染色体检测、诱导方案、完全缓解(CR)时间、复发时间、直接死因等进行分析。结果:急性淋巴细胞白血病、男性、白细胞数过高、化疗强度不够、出现髓外白血病、MRD(+)易复发,复发后放弃治疗或不规则治疗易全身浸润造成多器官脏器功能衰竭(MOF)死亡,化疗后骨髓抑制易出血、感染死亡。结论:白血病应坚持规范化、个体化长期治疗,停药后仍应定期监测以防复发,复发再诱导缓解后应进行干细胞移植根治白血病。

A Report on the Death of 17 Cases with Acute Leukemia with Survival Times of Over 5 Years

Objective:To study the cause of death for the patients with acute leukemia(AL)with survival time of over 5 years.Methods:The serial retrospective study was adopted to analyze the age of onset,sex,course of disease before chemotherapy,type of disease,case history,clinical manifestation,blood routine,myelogram,complications,minimal residual disease(MRD),tests for chromosomal abnormalities,induction plans,CR time,time of recurrence,direct cause of death,etc.for 17 cases of AL with survival times of over 5 years.Results:The factors affecting recurrence were as follows:acute lymphoblastic leukemia(ALL),male,exorbitant WBC,insufficient chemotherapy,and extramedullary leukemia.The cases with recurrence that stopped treatment early had systemic infiltration,resulting in death with multiple organ failure,or they died after hemorrhage and infection with post-chemotherapeutic myelosuppression.Conclusion:Long-term treatment with normalization and individualization for patients with AL should be developed.Regular monitoring after drug withdrawal is needed to prevent relapse.Stem cells transplants serve as a basic cure for AL.