儿童急性淋巴细胞白血病分型及其不同治疗方案与预后的临床研究

目的：研究儿童急性淋巴细胞白血病(ALL)的细胞形态学、免疫表型分型及不同方案治疗与预后的相关性。方法：采用骨髓涂片染色进行细胞形态学检查，采用单克隆抗体(McAb)和流式细胞仪(FCM)进行免疫表型检测。结果：103例儿童ALL患者中，67例(65．05％)为L1型，33例(32．04％)为L2型，无L2型，3例(4．91％)为其他。行免疫分型的87例中，58例(66．67％)为B系表达，12例(13．79％)为T系表达，10例(11．49％)为B系、髓系混合表达，3例(3．45％)为T系、B系混合表达，1例(1．15％)为T系、髓系混合表达，1例(1．15％)为B系、T系、髓系混合表达，2例(2．30％)为髓系表达。采用XH-88方案治疗25例，缓解卒92％，复发率52．17％，死亡率43．48％；协作组方案治疗41例，缓解率92．68％，复发率36．84％，死亡率55．26％；SUM-99方案治疗29例，缓解率93．10％，复发率18．52％，死亡率14．81％。结论：结合免疫分型与细胞形态学分型，将儿童ALL患者分为标危(SR)、中危(IR)和高危(HR)三组，按型采用不同的治疗方案对提高儿童ALL缓解率和降低其复发率有重要意义。

The clinical research among morphology and immunophenotype and different chemotherapeutic protocols in childhood acute lymphoblastic leukemia

Objective: To investigate the correlation among disease of morphologic classification, immunologic classification.different chemotherapeutic protocols and patients' prognosis in childhood acute lymphoblastic leuke-mia(ALL). Method:Cell immunophenotype was determined by flow cytometry. 95 patients with ALL were taken with xinhua-88'protocol ,the national childhood co-operation protocol of ALL and the therapeutic protocol of Sun Yat-sen University of Medical Sciences(SUM-99'protocol) differently, furthermore being followed-up. Result: A-mong 103 ALL,of 67(65. 05%)were diagnosed as ALL-L1,out of 33(32. 04%)as ALL-L2, 3(4. 91%)as others. Immunophenotypical analysis was carried out in 87 cases,lymphoblast of 58 cases(66. 67%)expressed B-cell antigen,of 12 cases(13. 79% ) T-cell antigen, of 10 cases(11. 49%) showed combination of B and myeloid antigen, 3 (3. 45%)combined B and T-cell antigen, 1 cased. 15%) T and myeloid antigen, and 1 case (1. 15%) T and B and myeloid antigen, 2 cases(2. 30%) were showed myeloid antigen . Twenty-five cases were treated with xinhua-88' protocol,and the CR rate was 92% ,the remission time was 24 days , the relapse was 52. 17% ,and the mortality was 43. 48%. Meanwhile 41 cases were treated with the national protocol, and the CR rate was 92. 68% , the relapse was 36. 84% ,and the mortality was 55. 26%. Moreover 29 cases were treated with the SUM-99'protocol, and the CR rate was 93. 10% ,the relapse was 18. 52% , the mortality was 14. 81% , however eight cases were given up in this group. Conclusion: These results suggested that childhood ALL in the protocol divided into standard-risk group, intermediate-risk group and high-risk group improve the prognosis of the leukemia. Immunophenotype has important value as the guidline for the choice of potocol with ALL.