小儿急性淋巴细胞白血病细胞形态特征与诱导化疗反应性的关系研究

本文观察了28例小儿急性淋巴细胞性白血病（ALL）患儿细胞形态特征与诱导化疗反应性间的关系。原幼淋巴细胞特征的主要观察项目为胞浆空泡、核仁及凋亡细胞。根据临床分型（标危型和高危型）分别应用DOP或DOAP诱导化疗，上述方案无效者改用VP16、大剂量MTX等有效的药物。结果提示：21例空泡计分≥15，在治疗较短时间内（20．8天）获完全缓解（CR），而空泡计分＜15的7例诱导CR时间显著延长（59．8天）（R＜0．O1）；细胞核仁清楚≥25％的18例患儿获CR时间为19．5天，另10例核仁不清楚≥75％在治疗较长时间内获CR（60．6天）（P＜O．01）；另外凋亡细胞数≥20％的8例患儿诱导CR时间明显延长（57．3天），20例调亡细胞数＜20％诱导CR时间（24．1天）。我们认为上述形态特征的观察及计分对判断CR的难易有指导意义，可供临床选择合适的治疗，减少并发症，提高治疗成功率。

MORPHOLOGICAL CLASSIFICATION AND RESPONSE TO INDUCED CHEMOTHERAPY IN CHILDHOOD ACUTE LYMPHOBLASTIC LEUKEMIA

From March 1985 to April 1995, 28 children with acute lymphoblastic leukemia (ALL)were enrolled on the Second Affiliated Hospital of Nanjing Medical University. As part of aprospective study designed to identify lymphoblastic features which were composed of vacuoles, nucleoli and apoptic cells, and which responded to induced chemotherapy. Accordingto clinical two groups (SRALL and HRALL), Patients individually received DOP or DOAPStatistic analysis showed that patients with higher vacuole score (≥ 15) acquired time ofcomplete remission (CR) to be shorter than lower vacuole score (＜15) (P＜ O. 01 ), that patients whose nucleoli presented in＞25% blast cells had well response than nucleli absent orinconspicuous in＞75 % lymphoblast cells (＜ O. 01 ). we also found that patients with higherPercentage of apoptic cells (≥ 20%) had risk manifestation and poor reaction to induceddrugs. percent of apoptic cells may become important index of prognostic factors of patient inALL This method can be widely applied by every hospital because the technique is simple,rapid and inexpensive