两种不同方案治疗儿童急性淋巴细胞白血病疗效分析

目的：比较两种治疗方案对小儿急性淋巴细胞白血病(ALL)治疗的近期完全缓解率(CR)与持续完全缓解(CCR)，探讨影响小儿ALL长期生存的有关因素。方法：根据化疗方案所用药物不同将44例患儿分为2组：一般化疗组(A组)，诱导治疗采用VCP(长春新碱、环磷酰胺、强的松)，庇护所预防使用二联鞘注(甲氨喋呤、地塞米松)，维持治疗使用6 巯嘌呤与甲氨喋呤，加强强化用VCP及COAP(长春新碱、环磷酰胺、阿糖胞苷、强的松)交替；强烈化疗组(B组)，按照1993年广西北海会议制定的小儿急性白血病诊疗建议进行序贯治疗，其中大剂量甲氨喋呤(HD-MTX)采用每次 1.5～2.0 g/m2及三联鞘注(甲氨喋呤、阿糖胞苷、地塞米松)。结果：两种方案经过4周治疗44例患儿均获CR，但达到CR的时间A组为(3.83±0.41)周，长于B组(3.00±0.82)周(P0.05)。结论：强烈化疗组不仅近期完全缓解所用时间短，而且在CCR及预防疾病复发上明显优于一般化疗组，虽然强烈化疗后合并各种感染的机会增多，但只要积极采取相应的预防措施，取得家长的密切配合可以使其发生率降低。

Therapeutic Effects of 2 Different Treatment Regimes on Childhood Acute Lymphoblastic Leukemia

Objective To compare the complete remission (CR) and continuous complete remission (CCR) resulting from two different treatment regimes for childhood acute lymphoblastic leukemia (ALL) and to explore the factors that could affect the long term survival of ALL patients. Methods Forty four patients were divided into two groups according to the chemotherapeutic regimes. In the conventional chemotherapy group (Group A, n=12), VCP(VCR, CTX, Pred) was used in remission induction therapy; MTX and Ara C were used in prophylactic therapy of extramedullary leukemia; 6 MP and MTX were used in maintenance therapy; and VCP and COAP (VCR, CTX, DXM and Pred) were used alternatively in consolidation and intensification. In the intensified chemotherapy group (Group B, n=32 ), the recommended regime for treating ALL laid down at the Beihai Convention in Guangxi, in 1983 was followed, though the dosage of HD MTX was ( 1.5 ～ 2.0 ) g/m 2 each time instead of the recommended dosage. Results After 4 weeks of treatment, CR was obtained in all of the 44 patients. But to obtain CR, it took ( 3.83 ± 0.41 ) weeks in Group A and ( 3.00 ± 0.82 ) weeks in Group B (P< 0.05 ). To obtain CCR, it took ( 20.31 ± 16.71 ) months in Group A and ( 43.5 ± 25.56 ) months in Group B (P< 0.05 ). There was significant difference in the incidence of recurrence between Group A and Group B ( 66.7% vs 32.5% , P< 0.05 ). No significant difference was found between the two groups in the occurrence of complications during the chemotherapy. Conclusions Patients of the intensified chemotherapy group not only obtained CR within a shorter period of time but also proved that the intensified chemotherapy is much better than the conventional therapy in both obtaining CCR and preventing the recurrence of ALL. The occurrence of complications resulting from chemotherapy could be prevented or reduced so long as appropriate measures are taken and close cooperations are provided by the parents of the patients. It is suggested that the intensified chemotherapy is more effective than the conventional one in childhood ALL.