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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。
A total of 74 children with acute lymphoblastic leukemia (ALL) who were admitted to our hospital from October 1991 to February 1996 were examined with bone marrow (BM) smears and biopsies. Eleven patients with secondary myelofibrosis (SMF ). Among them, BM smears in 5 cases were inconsistent with the histological sections, the degree of hyperplasia of the smears was reduced or extremely decreased, and the hyperplasia of the smears was extremely active (ranged from 2 to 5). The BM smears of 4 cases did not meet the diagnostic criteria of ALL. The number of infiltrating lymphocytes was less than 0.3 (0.08-0.25), and a lot of immature cells infiltrated in the sections. The number of peripheral blood leukocytes in 6 cases was less than 3 × 109 / L (1.3-2.79 × 109 / L). 4 cases of early VLP program based treatment, sustained complete remission time of 16 to 30 months, good effect. 2 cases of early treatment with VCP program, has not been completely relieved. BM sections showed increased adipose tissue (70% and 75%), poor efficacy. The results showed that the combination of the BM slice and the smear is of great value in the diagnosis of the second small ALL patients with SMF. The incidence of ALL with SMF in children may not be low. The success of the treatment is closely related to the early choice of chemotherapy.