两种不同方案治疗儿童急性淋巴细胞白血病骨髓复发的临床观察

Clinical effect of two different regimens in treatment of acute lymphoblastic leukemia children with bone marrow recurrence

摘要:

目的 回顾性分析两种不同再诱导方案治疗儿童急性淋巴细胞白血病（ALL）骨髓复发的短期疗效。方法 回顾性选择57例骨髓复发的ALL患儿为研究对象，根据治疗方案分为VMDP组（长春新碱+米托蒽醌+地塞米松+培门冬酰胺酶，n=42）和VIDP组（长春新碱+去甲氧柔红霉素+地塞米松+培门冬酰胺酶，n=15）。分析比较两组完全缓解率和不良反应发生率。结果 VMDP组和VIDP组完全缓解率（74% vs 73%）差异无统计学意义（P > 0.05）。所有患儿均发生3级或3级以上的血液学不良事件，VMDP组化疗相关病死率低于VIDP组（P < 0.05）。两组间感染发生率差异无统计学意义（P > 0.05）。结论 针对骨髓复发的儿童ALL，VMDP和VIDP再诱导方案均能获得较高的完全缓解率，且VMDP化疗方案引起的相关病死率更低，可作为儿童ALL骨髓复发再诱导方案的选择。

Abstract:

Objective To study the short-term effect of two different re-induction regimens in the treatment of acute lymphoblastic leukemia (ALL) children with bone marrow recurrence. Methods A retrospective analysis was performed for 57 ALL children with bone marrow recurrence. According to their treatment regimen, they were divided into two groups: VMDP (vincristine + mitoxantrone + dexamethasone + PEG-asparaginase; n=42) and VIDP (vincristine + idarubicin + dexamethasone + PEG-asparaginase; n=15). The two groups were compared in terms of complete response rate and incidence rate of adverse reactions. Results There was no significant difference in complete response rate between the VMDP and VIDP groups (74% vs 73%, P > 0.05). All children experienced grade ≥3 hematological adverse events. The VMDP group had a significantly lower chemotherapy-related mortality rate than the VIDP group (P < 0.05). There was no significant difference in the incidence rate of infection between the two groups (P > 0.05). Conclusions For ALL children with bone marrow recurrence, both re-induction regimens can achieve a relatively high complete response rate, and VMDP regimen has a lower chemotherapy-related mortality rate and can thus be used as an option for re-induction in ALL children with bone marrow recurrence.