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目的观察FLAG方案治疗儿童复发性急性淋巴细胞白血病(ALL)及非霍奇金淋巴瘤(NHL)短期疗效及安全性。方法回顾性分析经FLAG方案[氟达拉滨30 mg/m2,d 1～5,阿糖胞苷2 g/m2,d 1～5,粒细胞集落刺激因子5μg/(kg.d)]治疗的19例复发性ALL和NHL患儿临床资料,其中ALL 15例(初诊时高危8例,中危2例,低危5例),NHL 4例(临床分期为Ⅳ期);早期复发12例,晚期复发7例。观察其疗效、生存时间及不良反应。结果经1个疗程后,11例(73.3%)ALL患儿达完全缓解(CR),其中高危5例,中危1例,低危5例;2例(50.0%)NHL患儿达CR;6例(50.0%)早期复发患儿达CR,7例(100.0%)晚期复发患儿均达CR,CR率明显高于早期复发患儿(P<0.05)。13例CR患儿,中位无病生存时间5.5个月(2～12个月)。血液学毒性Ⅳ级8例,Ⅲ级4例,Ⅱ级4例;合并感染13例(68.4%),均得到有效控制;肝脏毒性Ⅲ级1例,Ⅰ级2例,经治疗后均恢复。结论 FLAG方案治疗儿童复发性ALL及NHL疗效显著,尤其对于晚期复发患儿疗效较好;不良反应可以耐受。
Objective To observe the short-term efficacy and safety of FLAG regimen in children with recurrent acute lymphoblastic leukemia (ALL) and non-Hodgkin’s lymphoma (NHL). Methods A retrospective analysis was performed to evaluate the efficacy and safety of fludarabine 30 mg / m 2, d 1 ~ 5, cytarabine 2 g / m 2, d 1 ~ 5, and granulocyte colony-stimulating factor 5 μg / (kg · d) 19 cases of recurrent ALL and NHL children with clinical data, including ALL 15 cases (newly diagnosed at high risk of 8 cases, 2 cases of intermediate risk, 5 cases of low risk), NHL 4 cases (clinical stage Ⅳ); early recurrence in 12 cases , Late recurrence in 7 cases. Observe its efficacy, survival time and adverse reactions. Results After a course of treatment, 11 cases (73.3%) of ALL patients achieved complete remission (CR), including 5 cases of high risk, 1 case of moderate risk and 5 cases of low risk; 2 cases (50.0%) of children with NHL achieved CR; CR was found in 6 cases (50.0%) of children with early recurrence and CR in 7 cases (100.0%) of late recurrence, the CR rate was significantly higher than that in early recurrence (P <0.05). Thirteen patients with CR had a median disease-free survival time of 5.5 months (range, 2-12 months). Hematological toxicity grade Ⅳ in 8 cases, grade Ⅲ in 4 cases, grade Ⅱ in 4 cases; combined infection in 13 cases (68.4%), were effectively controlled; liver toxicity in grade Ⅲ in 1 case, grade Ⅰ in 2 cases, recovered after treatment. Conclusion FLAG regimen has significant therapeutic effect on children with recurrent ALL and NHL, especially in children with advanced recurrent disease. Adverse reactions can be tolerated.