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目的对119例儿童标危型(SR)急性淋巴细胞性白血病(ALL)治疗的效果进行随访分析,探讨如何提高其生存率。方法119例SRALL采用CCLG97方案进行治疗。结果4周诱导治疗完全缓解(CR)率为97.4%;21例失访:1998年、1999年、2000年、2001年、2002年各年失访率为63%、14%、10%、8%、5%;1年、2年、3年、4年、5年、6年生存率分别为93.3%、90.2%、88.0%、85.0%、85.0%、85.0%;13例复发,总复发率为13.8%,9例单独骨髓复发中有5例与不规则治疗有关,占56%;2例为4周未CR者于2年内复发;2例为正规疗程中复发,1例为亚二倍体,1例免疫分型示T淋巴系表达;4例为单独中枢神经系统(CNSL)复发,复发率为4.3%;全部患儿无睾丸白血病(TL)发生,无第二肿瘤发生。死亡15例,病死率为12.6%,化疗相关死亡5例,占4.2%。结论加强管理与正规治疗是提高我国儿童ALL长期存活率的重要措施之一;须在提高检测手段的基础上调整临床分型标准,CCLG97方案在减少标危型ALL骨髓复发的同时,并未增加化疗相关死亡率;应积极开展大剂量氨甲蝶呤(HDMTX)的治疗,进一步探索其剂量、用法及个体化的应用。
Objective To investigate the effect of 119 children with acute lymphoblastic leukemia (ALL) treated with standard-risk (ALL) treatment and to explore how to improve their survival rate. Methods 119 cases of SRALL were treated with CCLG97 regimen. Results The complete remission (CR) rate was 97.4% after 4 weeks of induction therapy and 21 cases were lost to follow-up: the lost rate was 63%, 14%, 10% and 8 respectively in 1998, 1999, 2000, 2001 and 2002 %, 5%. The survival rates at 1 year, 2 years, 3 years, 4 years, 5 years and 6 years were 93.3%, 90.2%, 88.0%, 85.0%, 85.0% and 85.0% The rate was 13.8%. Five of 9 patients with recurrent bone marrow were associated with irregular treatment, accounting for 56%. Two patients with non-CR in 4 weeks relapsed within 2 years. Two patients relapsed during the regular course of treatment and one patient was sub-II Ploidy and 1 immunophenotype showed T lymphatic system expression. Four cases had CNSL recurrence with a recurrence rate of 4.3%. All children had no testicular leukemia (TL) and no secondary tumor. 15 cases died, the case fatality rate was 12.6%, chemotherapy-related death in 5 cases, accounting for 4.2%. Conclusion Strengthening management and regular treatment are one of the important measures to improve the long-term survival rate of children in our country. On the basis of improving the detection methods, the clinical classification criteria should be adjusted. The CCLG97 regimen did not increase the ALL bone marrow relapse Chemotherapy-related mortality; should actively carry out high-dose methotrexate (HDMTX) treatment, to further explore the dose, usage and individualized applications.