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目的 :研究儿童急性淋巴细胞白血病 (ALL)的治疗及其相关预后因素。 方法 :以多药联合化疗方案进行诱导缓解和缓解后治疗 ,以诱导治疗第 1 4天的骨髓原始淋巴细胞比例作为治疗反应敏感性指标 ,以端粒重复序列扩增 银染色技术检测端粒酶活性作为微小残留白血病指标。 结果 :90 % (1 9/ 2 1 )的儿童ALL获完全缓解(CR)。在中位随访时间 5 5 (1 2～ 1 2 0 )个月内 ,6例复发 ,7例已连续完全缓解 (CCR) 2 4～ 5 4个月 ,现仍在连续治疗中 ;6例已停止治疗 1 8～ 6 0个月。全组患儿 5年无复发生存率为 6 5 .5 %。诱导治疗第 1 4天骨髓检查分级为M1(原始细胞为 <5 % )、M2 (原始细胞 5 %～ 2 5 % )和M3 (原始细胞 >2 5 % )型者分别为 6 7%、1 4 %和 1 9%。 1 4例M1 型ALL的 5年无复发生存率明显高于 7例M2 和M3 型 (分别为 84 .6 %和 1 5 .8% ,P <0 .0 1 )。在CR后端粒酶持续阳性或在治疗期间由阴性转为阳性的ALL复发率明显增加。 结论 :诱导治疗第 1 4天骨髓检查结果是判断ALL长期存活的重要预后因素 ;不同治疗阶段检测骨髓细胞端粒酶活性可作为微小残留白血病指标
Objective: To study the treatment of childhood acute lymphoblastic leukemia (ALL) and its associated prognostic factors. Methods: The multi-drug combined chemotherapy regimen for induction of remission and post-remission treatment to induce the proportion of bone marrow lymphocytes on the 14th day of treatment as a sensitive indicator of response to telomere repeat amplification silver staining to detect telomerase Activity as an indicator of minimal residual leukemia. Results: 90% (19/21) of children with ALL had complete remission (CR). In the median follow-up period of 55 (1220) months, 6 patients relapsed and 7 patients had continuous complete remission (CCR) 24 to 54 months, and is still under continuous treatment. Six patients have been treated Stop treatment 18 ~ 60 months. The 5-year recurrence-free survival rate of all patients was 65.5%. On the 14th day after induction therapy, bone marrow examination was graded as M1 (original cells <5%), M2 (5% ~ 25% of original cells) and M3 (original cell> 25% 4% and 19%. The 5-year recurrence-free survival rate was significantly higher in 14 cases of M1 ALL than in 7 cases of M2 and M3 (84.6% vs 15.8%, P <0.01, respectively). The relapse rate of ALL with persistent positive telomerase in CR or negative from positive to positive during treatment was significantly increased. CONCLUSION: The results of bone marrow test on the 14th day of induction therapy are important prognostic factors in judging the long-term survival of ALL. The detection of telomerase activity in bone marrow cells in different treatment stages can be used as an indicator of minimal residual leukemia