大剂量阿糖胞苷治疗儿童急性髓系白血病远期疗效的研究.docVIP

大剂量阿糖胞苷治疗儿童急性髓系白血病远期疗效的研究 　　[摘要]目的 探索采用大剂量阿糖胞苷（HD-AraC）治疗儿童急性髓系白血病（AML）的远期疗效。 方法以HD-AraC为主的联合方案作为儿童AML长期化疗中的早期和定期强化治疗，采用Kaplan-Merier法统计长期无病生存（DFS）率。采用综合措施防治强烈化疗后并发症。采用高效液相色谱法（HPLC）测定血浆和脑脊液中Ara-C浓度。 结果16例初治患者的6年以上DFS率达到62.5％（10/16例）；持续完全缓解5年以上7例，3～5年2例。但复发病例疗效仍不理想。采用积极的化疗并发症防治措施，患儿均能够度过骨髓抑制期，未出现重要脏器明显损伤和化疗相关死亡。HPLC检测显示HD-AraC治疗可以明显提高血浆和脑脊液中Ara-C浓度。 结论以HD-AraC为主的联合方案治疗儿童AML可进一步提高远期疗效，患儿能够耐受该化疗方案的强度，值得临床应用。? 　　[关键词] 髓系白血病；儿童；大剂量阿糖胞苷；疗效；药物浓度? 　　[中图分类号] R733.71;R730.53 　　[文献标识码] A 　　[文章编号] 1671-7562(2007)02-0115-04?? 　　 　　Long-term therapeutic effect of high-dose Ara-C based protocols ?on childhood acute myeloblastic leukemia?? 　　ZHOU Xiao-xun,XIE Xiao-tian,SHI Wei,JIANG Sha-yi,LI Ben-shang 　　（Department of Pediatric Hematology Oncology,Tongji Hospital,Tongji University,Shanghai 200065,China）?? 　　Abstract：Objective To study the long-term therapeatic effect of high-dose Ara-C (HD-AraC) based protocols on childhood acute myeloblastic leukemia (AML).Methods HD-AraC based protocols were used as early and regular intensification regimens to treat childhood AML,and the long-term disease free survival (DFS) rate was calculate with Kaplan-Merier method.Comprehensive procedures were proceeded to protect and treat the chemotherapy related complications.Concentration of Ara-C in plasma and cerebrospinal fluid（CSF）was determined by HPLC.Results More than 6 years DFS rate was achieved to 62.5%(10/16) in 16 newly diagnosed cases,7 cases got continuous complete remission (CCR) for more than 5 years and 2 for 3 to 5 years,but the outcomes were not good in relapsed cases.By using the comprehensive procedures to protect and treat the intensive chemotherapy related complications,all patients recovered from bone marrow suppression after intensive chemotherapy,and there was no evident side-effects could be found and no chemotherapy related death appeared.The study showed that the concentration of Ara-C in plasma and CSF could be significantly elevated by HD-AraC therapy.Conclusio