高白细胞急性白血病三种疗法的疗效比较

目的 :探讨用白细胞去除术加联合化疗、羟基脲 (HU)加联合化疗及单用联合化疗治疗高白细胞急性白血病 (HAL)的疗效的差别。方法 :5 3例HAL随机分为三组 ,HAL1组和HAL2组分别先行白细胞去除和口服HU ,显著降低白细胞后再行联合化疗 ,HAL3组单用联合化疗 ,观察其疗效及不良反应。 30例非高白细胞急性白血病 (NHAL)单用联合化疗作为对照组。结果 :HAL1组与HAL2组间完全缓解 (CR)率、早期病死率无显著差异 ,白细胞去除和口服HU无严重不良反应 ,其CR率均显著高于HAL3组 (P <0 .0 5 ) ,而早期病死率低于后者。生存率分析未发现各HAL组间有明显差异 ,且各HAL组生存率均低于NHAL组。结论 :白细胞去除术及HU口服对降低HAL患者的白细胞是有效、安全的 ,随后行联合化疗可显著提高近期疗效 ,但对远期生存率尚未发现有明显改善。

The Comparative Effect of Three Protocols in Treatment of High Leukocytic Acute Leukemia

Objective: To investigate the efficacy of different protocal (leukopheresis with combination chemotherapy, hydroxyurea (HU) with combination chemotherapy, combination chemotherapy alone) in treatment of high leukocytic acute leukemia(HAL). Methods: 53 patients with HAL were divided randomly into 3 groups.HAL1 group and HAL2 group were respectively treated with leukopheresis or HU firstly to lower leukocytic count significantly, then treated with combination chemotherapy. HAL3 group was treated with combination chemotherapy alone. The clinical therapeutic effects and side effect were observed. 30 patients with non high leukocytic acute leukemia(NHAL) being treated with combination chemotherapy alone were as control group. Results: The difference between HAL1 group and HAL2 group in complete remission (CR) rates and early mortality rate was not statistically significant. During leukopheresis and HU administration, no severe side effect was found. CR rate of the two groups was significantly higher than that of HAL3 group ( P < 0.05 ),meanwhile, their early mortality rate was lower than that of group 3. There was no statistical difference in survival rate among three HAL groups. The survival rate of all 3 HAL groups was lower than that of NHAL group.Conclusion: Leukopheresis and HU administration are effective and safe to lower leukocytic count of HAL patients, subsequent combination chemotherapy is markedly beneficial to early therapeutic effect, but survival rate can't be significantly improved.