糖皮质激素诱导试验与儿童急性淋巴细胞性白血病预后的关系

目的　通过糖皮质激素早期诱导试验评估儿童急性淋巴细胞性白血病的预后。方法　诱导试验是根据初发病时外周血幼稚细胞计数及服用糖皮质激素 (GC) 7d后外周血中幼稚细胞的动态变化。此后 ,所有病例都接受同样强烈的化疗方案。结果　 6 0例患儿中对泼尼松诱导试验敏感 (PGR)者为 4 9例 ,占 81 7% ,其中高危患儿 6例 ,中危患儿 8例 ,低危患儿 35例。在 4 9例PGR患儿中 38例 (77 6 % )处于持续缓解状态 (CCR) ,中位缓解期为 2 2 5个月 ;复发 3例 ,占 6 1%。 6 0例患儿中对泼尼松诱导试验不敏感 (PPR)者为 11例 ,占 18 3%。在PPR 11例中 ,5例早期复发 ,占 4 5 5 % ;2例达CCR ,占 18 2 %。从治疗第 19天、第 30天的骨髓检查 ,PPR组 19dM1、M2 、M3分别为 72 7%、18 1%、9 2 % ;PGR组 19dM1、M2 分别为 96 %、4 % ,无一例为M3 。达CR时间 ,PPR组明显迟于PGR组。结论　GC在用于治疗恶性淋巴细胞增生性疾病中 ,起到了重要作用。

Glucocorticosteroid induction test and the prognosis of children acute lymphoblastic leukemia

Objective To predict the prognosis of children acute lymphoblastic leukemia (ALL) by using glucocorticosteroid induction test.Methods The dynamic changes of the blast cells in the peripheral blood were monitored before and 7 days after glucocorticosteroid treatment.Then,all children received the same intensive combination chemotherapy protocols.Results Of 60 children,49(81.7%) belonged to prednison good responder (PGR) group including 6 in high risk,4 in intermediate risk and 39 in low risk.Of 49 PGRS 38(70.7%) remained in continuous complete remission (CCR) and the medium remission time was 22.5 months.Three of them (6%) relapsed.While 11/60 children (18.3%) were prednison poor responders (PPR) with 5 children in early relapse (45%) and 2 still in CCR (18.2%).Bone marrow were examined on the 19 and 30 days after treatment,M1,M2,M3 states were reached on 19 days after treatment in PPG with 72.2%,18.1% and 9.2% respectively.While in PGR group,96% and 4% children achieved M1 and M2 status respectively on 19 days with no one in M3 status PPR group was slower in reaching CR than PGR group.Conclusion Glucostricosteroid treatment for children with acute lymphobaltic leukemia is effective.