儿童急性淋巴细胞白血病的临床分析

目的 分析初诊儿童急性淋巴细胞白血病的临床特征及远期疗效情况,提高急性淋巴细胞白血病患儿的总生存率（overall survival,OS）和无事件生存率（event-free survival,EFS）.方法 收集2005年至2010年住院治疗的初诊急性淋巴细胞白血病80例患儿的临床资料,采用急性淋巴细胞白血病IC-BFM2002为基础的化疗方案,运用Kaplan-Meier法统计分析患儿的5年OS和EFS.结果 80例患儿,男女比例1.22∶1,中位年龄4岁3个月,标危33例（41.2％）,中危37例（46.3％）,高危10例（12.5％）,白细胞（WBC≥20×109/L）22例（27.5％）,BCR/ABL阳性3例（3.8％）;MLL基因重排1例（1.3％）;TEL/AML阳性17例（21.3％）.完全缓解79例（98.8％）,5年OS和EFS分别为（85.9±4.0）％和（79.2±4.7）％,其中标危组5年EFS（86.6±6.4）％,中危组5年EFS （81.1±6.4）％,高危组5年EFS（48.0±16.4）％,组间比较差异有统计学意义（x2=7.03,P＜0.05）.复发12例（15.o％）,中位时间23.5个月.死亡11例（13.8％）,中位时间13个月.结论 初诊儿童急性淋巴细胞白血病患儿的疗效好,标准的分型诊断及危险度分层治疗有利于提高患儿的生存质量.

Clinical analysis of children acute lymphoblastic leukemia

Objective To analysis the clinical characteristics and the long-term effect of children with acute lymphoblastic leukemia （ALL）.Methods From 2005 to 2010,80 newly diagnosed ALL children were enrolled and treated with protocol based on ALL-BFM2002.The five-years overall survival （OS）and event-free survival（EFS） were analyzed by the method of Kaplan-Meier.Results For the 80 patients,male to female ratio is 1.22∶1.The median age was 4.3 years.33 were in standard risk（41.2％）,37 were in medium risk（46.3％）,and 10 were in high risk（12.5％）.22 had white blood cell count ≥20 x 109/L（27.5％）.three patients with BCR-ABL translocation（3.8％）,one patient with MLL gene rearrangement（1.3％）,17 patients with TEL-AML translocation （21.3％）.During induction therapy,79 patients （98.8 ％） achieved complete remission（CR）.The five-years OS and EFS were （85.9 ± 4.0） ％ and （79.2 ± 4.7） ％ respectively.The five-years EFS：SR group （86.6 ± 6.4） ％,IR group （81.1 ± 6.4） ％,HR group （48.0 ± 16.4） ％.The difference among risk groups was statistically significant（x2 =7.03,P ＜0.05）.12 patients relapsed（15.0％）,the median time from diagnosis to relapse was 23.5 months.11 patients died （13.8 ％）.Conclusion According to stratification by risk factors and risk-adapted therapy,the quality of ALL children＇s life had improved.