小儿急性淋巴细胞性白血病伴继发骨髓纤维化及疗效观察

对1991年10月至1996年2月收治的74例小儿急性淋巴细胞性白血病（ALL）同时作骨髓（BM）涂片与切片（活检）检查，发现11例伴有继发骨髓纤维化（SMF）。其中5例BM涂片与切片增生度不相符，涂片增生度减低或极度减低，切片示增生活跃至极度活跃（相差2～5个级别）；4例BM涂片未达ALL诊断标准，原淋＋幼淋＜0．3（0．08～0．25），切片见大量幼稚细胞浸润；6例外周血白细胞＜3×109/L（1．3～2．79×109/L）。4例早期用VLP方案为主治疗，持续完全缓解时间为16～30个月，疗效良好。2例早期用VCP方案治疗，一直未能完全缓解。BM切片示脂肪组织增多（70％和75％），疗效差。结果表明：BM切片与涂片结合对小二ALL伴SMF的诊断有重要价值；小儿ALL伴SMF的发生率可能不低；其治疗的成功与否与化疗早期的选择关系密切。

ACUTE LYMPHOCYTIC LEUKEMIA WITH SECONDARY BONE MARROW FIBROSIS(SMF)IN CHILDREN AND TREATMENT OBSERVATION

Observed and summarized the difference between the bone marrow(BM) smears and BM biopsies of 11 children and their treatment results of ALL with SMF in 74 ALL(14. 88%). In 5 cases the BM proliferation degree in smears appeared low/extremely low. But in biopsies showed active to extremely active. In 4 cases the rate of the primitive lymphocytes in BM smears were＜0. 3(0. 08-0. 25). But in BM biopsies there were large amount of lymphocytoblasts. 4 cases were treated with VLP plan mainly and 2 with VCP plan at the initial stage of the chemical treatment (CT). The 4 with VLP get complete remission (CR) in 5-7 weeks,and their CCR time were 16-30 monthes. The 2 with VCP showed unsuccessful. Their BM biopsies showed extremely low proliferation and fat tissues were 70% in 5-9 weeks after CT. The results showed: Combining BM smears with BM biopsies to diagmose ALL with SMF in children is very useful; the morbidity of ALL with SMF in children may not be rare; the success of therapy in All with SMF is related to the CT drug selected at the initial stage of the treatment.