地塞米松诱导实验在儿童急性淋巴细胞性白血病预后中的作用

目的：通过地塞米松早期诱导试验探讨糖皮质激素（GC）在评估儿童急性淋巴细胞性白血病预后中的作用。方法：地塞米松诱导试验敏感与否是根据初发病时外周血幼稚细胞计数及服用地塞米松7d后外周血中幼稚细胞的动态变化而定。此后，所有患儿均接受同样程度的化疗方案。结果：52例患儿中对地塞米松诱导试验敏感（DGR）者为40例，占77％，其中高危患儿6例，标危患儿34例。在40例DGR患儿中，29例（72．5％）处于持续缓解状态（CCR），复发3例，占7．5％。52例患儿中对地塞米松诱导试验不敏感（DPR）者为12例，占23％，其中15例早期复发，占42％，3例持续缓解，占25％。从治疗第15天、第28天的骨髓检查，DGR组15dM．、M，分别为95％、5％，无一例为M3。DPR组15dM1、M2、M3分别为58．3％、25％、16．7％。达完全缓解时间，DPR组明显迟于DGR组。结论：GC在用于治疗急性淋巴细胞白血病中具有重要作用。

The Effect of Dexamethasone Induction Test on the Prognosis of Children Acute Lymphoblastic Leukemia

Objective: To predict the effect of Glucostricosteroid(GC) on the prognosis of children acute lymphoblastic leukemia(ALL) by using Dexamethasone induction test. Methods: The dynamic changes of the blast cells in the peripheral blood were monitored before and 7days after Dexamethesone treatment.Then,all children received the same intensive combination chemotherapy protocols. Results: Of 52 children,40(77%)belonged to Dexamethasone good responder(DGR) groop including 6 in high risk and 34 in low risk.Of 40 DGRS 29(72.5%)remained in continuous complete remission(CCR) and three of them((7.5%))relapsed.While 12/52 children(23%) were Dexamethasone poor responders(DPR) with 5 children relapse(42%) and 3 still in CCR(25%).Bone marrow were examined on the 15 and 28 days after treatment,M_1,M_2,M_3 states were reached on 15 days after treatment in DPR with 58.3%,25% and 16.7% respectively.While in DGR group,95% and 5% children achieved M_1 and M_2 status respectively on 15 days with no one in M_3 status.DPR group was slower in reaching CR than DGR group. Conclusion: Glucostricosteroid treatment for children with acute lymphobaltic leukemia was effective.