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【目的】探讨影响我国儿童高危急性淋巴细胞白血病(HR-ALL)治疗和预后的因素。【方法】收集1999年5月-2007年3月在我院儿科初诊符合HR-ALL的患儿76例,其中VHR-ALL组41例。治疗上非VHR-ALL用蓉城98高危或ALLIC BFM2002MR方案化疗,VHR-ALL用中山大学附属第一医院高危方案化疗。【结果】总放弃治疗率25%,总预期6年无事生存率(EFS)49.3%,坚持治疗者EFS64.7%,非VHR-ALL组坚持治疗者EFS78.8%。Cox模型分析显示诱导33d不缓解或BCR-ABL阳性是不良的独立预后因素,高强度化疗不能改变其预后差的特性,而泼尼松不敏感与其它任一项高危因素并存时复发的危险性明显增高。【结论】放弃治疗和复发是本组治疗失败的前2位原因,多数HR-ALL如能坚持合理治疗应有信心获得较好的预后,诱导33d不缓解或BCR-ABL阳性患者应争取造血干细胞移植,2项或以上高危因素并存对预后的影响值得深入研究。
【Objective】 To explore the factors influencing the treatment and prognosis of children with high-risk acute lymphoblastic leukemia (HR-ALL) in our country. 【Methods】 A total of 76 children with HR-ALL who were admitted to our hospital from May 1999 to March 2007 were collected, of which 41 were VHR-ALL. Treatment of non-VHR-ALL with Chengdu high-risk or ALLIC BFM2002MR 98 chemotherapy, VHR-ALL with the First Affiliated Hospital of Sun Yat-sen high-risk chemotherapy. 【Results】 The total abandonment treatment rate was 25%, the total expected 6-year EFS was 49.3%, persistence of treatment EFS was 64.7%, and that of non-VHR-ALL group was 78.8%. Cox model analysis showed that induction of 33 days without remission or positive BCR-ABL is an independent prognostic factor, high-intensity chemotherapy can not change the poor prognosis of the characteristics of prednisone insensitivity and any other risk factors co-exist when the risk of recurrence Significantly higher. 【Conclusion】 Abandonment of treatment and relapse is the first two causes of failure in this group. Most HR-ALL patients should have the confidence to get a good prognosis if they are able to adhere to reasonable treatment. Patients with positive or negative BCR-ABL should be given anti-hematopoietic stem cells Transplantation, the coexistence of two or more risk factors on the prognosis deserves further study.