儿童急性淋巴细胞性白血病两种化疗方案的初步临床疗效评价

 目的　分析比较"广州地区儿童急性淋巴细胞性白血病协作组方案"（GZ-ALL-2002,简称A方案）与"全国荣成-ALL-98方案"（RC-ALL-98,简称B方案）治疗儿童急性淋巴细胞性白血病（ALL）的效果。方法　82例儿童ALL患儿中,A方案（根据 IC BFM-2002修订）治疗51例,危险度（HR）分3型,总疗程2年; B方案治疗31例,危险度分2型,总疗程3～3.5年。结果　并发症：较严重感染A组77例次、B组108例次;左旋门冬酰胺酶（L-ASP）相关并发症：A组7例、B组9例;治疗相关死亡：A组0例、B组5例（16.8 ％）,其中感染相关死亡4例（12.9 ％）。治疗效果：完全缓解（CR）率两组均达100 ％;随访3～48个月,A组除4例CR后不再治疗者外其余未见复发,B组6例复发。生存分析初步显示在两组或按统一分型后的两中危亚组间预后差异均有统计学意义（P＜0.02）。从临床分型的科学性、治疗的合理性、感染的发生情况、治疗相关死亡率及治疗总费用等方面比较,A方案优于B方案。结论　A方案是目前治疗儿童ALL的先进方案之一。

Primary assessment of curative effects of two protocols in children with acute lymphoblastic leukemia

Objective　To analyze the primary difference effects between two protocol ( A. GZ2002; B. RC98 ) in treatment of childhood acute lymphoblastic leukemia ( ALL). Methods　Total 82 cases of ALL from Oct. 2002 to Jun.2006, 51 cases treated with GZ-ALL-2002 protocol (A) (modified from ICBFM2002 ), in this group patient stratification was in 3 types and total therapy schedule are 2 years; 31 cases with RC-ALL-98 (B) protocol, in which group stratification was in 2 types and the schedule are 3-3.5 years. Results　The complications: the infection in group A were 77 cases/times and in group B were 108; The complications associated with L-ASP in group A were 7 cases and in group B were 9; The death associated with treatment in group A was zero but in group B was 5/31(16.8 %) and death with severe infection were 4/31 (12.9 %).　The curative effects: the rates of complete remission (CR) in two groups were both 100 %. After 3~48 months fol－low-up, relapse in group A did not occurred (except 4 cases gave up therapy after CR) but in B 6 cases did. Primary statistical analysis showed that survival was different between two groups or the two intermediate risk sub-groups based on the uniform stratification standard(P <0.02). Conclusion　According to the data of this paper, the rates of CR were both high in these two groups. But, considering the scientific patient stratification, the rationalization treatment, the occurrence of severe infection, the death from treatment and the cost of ther－apy, A protocol is superior to B protocol. So, A is one advanced protocol to cure children ALL so far.