儿童白血病--急淋白血病.ppt

Treatment A total therapy approach, devised by Pinkel and colleagues at St. Jude Childrens Research Hospital in 1962, consisted of four treatment phases: remission induction, intensification or consolidation, therapy for subclinical central nervous system (CNS) leukemia (or preventive meningeal treatment), and prolonged continuation therapy Treatment Metabolic Complications Hyperleukocytosis Infection Control Hematologic Support Antileukemic Therapy protocol Remission Induction Intensification (Consolidation) Therapy Continuation Therapy Therapy of the CNS(second cancer, late neurocognitive deficits, and endocrinopathy ) Treatment Acute Complications Delayed Complications Prednisone (or prednisolone) Hyperglycemia, hypertension, changes in mood or behavior, acne, increased appetite, weight gain, peptic ulcer, hepatomegaly, myopathy Avascular necrosis of bone, osteopenia, growth retardation Dexamethasone Same as prednisone, except for increased changes in mood or behavior and myopathy but less salt retention Same as prednisone Vincristine Peripheral neuropathy, constipation, chemical cellulitis, seizures, hair loss None Daunorubicin, idarubicin, doxorubicin, or epirubicin Nausea and vomiting, hair loss, mucositis, bone marrow suppression, chemical cellulitis, increased skin pigmentation, hair loss Cardiomyopathy (with high cumulative dose) L-Asparaginase? Nausea and vomiting, allergic reactions (manifested as rashes, bronchospasm, severe pain at intramuscular injection site), hyperglycemia, pancreatitis, liver dysfunction, thrombosis, encephalopathy None Methotrexate Nausea and vomiting, liver dysfunction, bone marrow suppression, mucositis (resulting from high-dose treatment), solar dermatitis Leukoencephalopathy, osteopenia (resulting from long-term use) Etoposide, teniposide Nausea and vomiting, hair loss, mucositis, bone marrow suppression, allergic reactions (bronchospasm, urticaria, angioedema, hypotension) Acute myeloid leukemia Etoposide, teniposide N