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目的 分析近几年利用荣成98方案对重庆地区儿童淋巴细胞白血病(ALL)的诊治状况,初步评估1999年全国ALL诊疗建议的方案的应用效果。方法 对2 0 0 0年1月至2 0 0 4年4月重庆医科大学附属儿童医院新诊ALL患儿2 31例,参照1999荣成诊疗建议进行诊断、分型及治疗,分年龄组进行统计分析比较。结果 近3年ALL病例数逐渐增加;患儿初诊时临床表现较重;婴儿高白细胞(WBC)者为80 .0 0 % ,而10岁以上患儿为14 .2 8% ;骨髓增生程度与WBC计数不完全一致。B ALL和T ALL分别占86 . 76 %和13. 2 4 % ,合并髓系标志表达者14 . 71% ;具有染色体数目或结构异常的患者标本为76 % ,激素实验不敏感者10 . 14 % ,而HR ALL占4 9. 6 6 %。接受化疗者5 8例,完全缓解率89 .5 8% ;骨髓复发9例,复发率17% ;4 1例患儿坚持治疗,进入维持治疗2 1例,无病生存率为83%。结论 所在医院近3年ALL病例逐渐增加;本文ALL患儿初诊时的临床表现较重;高白细胞血症见于多数婴儿白血病患儿;坚持规范的化疗是决定预后的最重要因素;荣成98方案治疗结果显示完全缓解率89. 5 8% ,无病生存率83% ,复发率17% ,大剂量氨甲蝶呤对中枢神经系统白血病预防起到了重要作用。
Objective To analyze the diagnosis and treatment of childhood lymphoblastic leukemia (ALL) in Chongqing using Rongcheng 98 regimen in recent years, and to evaluate the application effect of the scheme of ALL nationwide diagnosis and treatment in 1999. Methods From January 2000 to April 2004, 241 newly diagnosed ALL children at Chongqing Children’s Hospital of Chongqing Medical University were diagnosed, classified and treated according to 1999 Rongcheng diagnosis and treatment recommendations, and statistics were made by age group analyse and compare. Results The number of cases of ALL gradually increased in the recent 3 years. The clinical manifestations of the patients were severe at the time of first visit. The prevalence of infants with high white blood cell (WBC) was 80.0% and that of children over 10 years old was 14.28% WBC count is not exactly the same. B ALL and T ALL accounted for 86.76% and13.24%, respectively, with 14.71% of those with myeloid markers, 76% of patients with chromosomal abnormalities or structural abnormalities, and less sensitive to hormone tests.10.14 %, While HR ALL accounted for 4.96.6%. Fifty-eight patients underwent chemotherapy, with a complete remission rate of 89.58%. Nine patients had bone marrow recurrence with a recurrence rate of 17%. Four of the 11 children were persisted in their therapy and 21 were in maintenance therapy. The disease-free survival rate was 83%. Conclusions The ALL cases in the hospital were gradually increased in the recent 3 years. The clinical manifestations of ALL patients were heavy at the time of first visit. Hyperleukocytosis was found in most of the infants with infant leukemia. The standardized chemotherapy was the most important factor in prognosis. The results showed that the complete remission rate of 89.58%, disease-free survival rate of 83%, the recurrence rate of 17%, high-dose methotrexate has played an important role in the prevention of central nervous system leukemia.