去甲氧柔红霉素联合方案治疗难治性急性淋巴细胞白血病的远期疗效

目的探讨应用去甲氧柔红霉素（ＩＤ）为主的联合化疗方案治疗难治性儿童急性淋巴细胞白血病（ＡＬＬ）的远期疗效及其临床应用价值。方法初治诱导缓解方案用ＶＩＬＰ（长春新碱、去甲氧柔红霉素、左旋门冬酰胺酶、泼尼松）。完全缓解（ＣＲ）后作巩固治疗及庇护所治疗，然后再用ＶＩＬＰ作早期强化治疗。复发者诱导治疗用ＩＡ（去甲氧柔红霉素、阿糖胞苷）方案。ＣＲ后巩固和早期强化治疗用初治者同样方案。结果１０例初治患儿９例获ＣＲ，７例复治患儿５例获ＣＲ，总ＣＲ率为８２％（１４／１７）。ＣＲ的１４例中持续ＣＲ（ＣＣＲ）＞３年者４例，＞２年者４例，＞１年者１例。结论用去甲氧柔红霉素为主的联合方案是治疗难治性儿童ＡＬＬ有效的方法，对初治患儿作为一线药物其远期疗效会更好。

The long term effect of idarubicin in combined chemotherapy for refractory childhood acute lymphoblastic leukemia

Objective To explore the long term effect and clinical value of idarubicin in combined chemotherapy for refractory childhood acute lymphoblastic leukemia. Methods The cases de novo were induced by VILP [vincristine, ldarubicin (ID), L asparaginase and prednisone] and consolidated by CAT (cyclophosphamide, Ara C and 6 TG) after CR. Then it was followed by early intensified therapy with VILP (ID was administrated for twice). The cases of relapse were induced by IA (ID and Ara C). After CR, the consolidation protocal was equal to that for the cases de novo. Results 9/10 (90%) cases de novo and 5/7 of relapse obtained CR with a total rate of 82% (14/17). Among the 14 cases in CR, 4 were in their continuous complete remission (CCR) for more than 3 years, another 4 for more than 2 years and one for more than 1 year. Conclusion Combined chemotherapy of dominant treatment with ID is an effective method for refractory childhood acute lymphoblastic leukemia, especially for the cases de novo.