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目的回顾性分析初治儿童ALL应用中剂量阿糖胞苷(IDAC)进行早期强化的疗效及不良反应。方法2003年1月-2007年9月初治并接受序贯治疗的81例ALL患儿,根据其细胞形态学、免疫学、细胞遗传学和分子生物学进行危险分组,分为中危组和高危组。经标准的首次诱导缓解方案治疗达完全缓解后,采用IDAC[1g/(m2.次)],每12h1次,持续3h,共6次,在化疗第1-3天应用,联合环磷酰胺、6-硫鸟嘌呤组成的CAM方案或联合替尼泊苷组成TA方案进行早期强化治疗。采用SPSS13.0软件进行统计学分析。结果1.本组患儿的总完全缓解率为97.5%,3a、5a无事件生存(EFS)率分别为86.1%和72.3%。中危组3a预期EFS率[(85.9±6.0)%]显著高于高危组[(58.0±9.5)%](P=0.047)。2.不良反应主要为各系血细胞减低、感染等,无治疗相关死亡。结论1.采用早期IDAC强化治疗可显著提高中、高危ALL患儿的疗效,明显提高ALL患儿的长期无病生存率。2.IDAC强化治疗方案的不良反应可耐受,可作为中、高危ALL的巩固强化治疗。
Objective To retrospectively analyze the curative effect and adverse reactions of mid-dose cytarabine (IDAC) in early-stage pediatric ALL patients for early enhancement. Methods From January 2003 to September 2007, 81 children with ALL who received primary treatment and received sequential therapy were divided into two groups according to their cell morphology, immunology, cytogenetics and molecular biology. They were divided into moderate-risk group and high-risk group group. IDAC [1g / (m2. Times)], every 12h1, for 3h, a total of 6 times, the first 1-3 days of chemotherapy with cyclophosphamide, 6-thioguanine CAM program or combination of teniposide TA scheme for early intensive treatment. SPSS13.0 software was used for statistical analysis. The overall complete remission rate was 97.5% in this group of children, and the event-free survival (EFS) rates at 3a and 5a were 86.1% and 72.3% respectively. The median EFS rate of the moderate-risk group 3a [(85.9 ± 6.0)%] was significantly higher than that of the high-risk group (58.0 ± 9.5%) (P = 0.047). 2. Adverse reactions mainly for the department of blood cells, infection, no treatment-related deaths. Conclusion 1. Early IDAC intensive treatment can significantly improve the treatment of children with middle and high risk ALL, significantly improve the long-term disease-free survival of children with ALL. 2.IDAC intensive treatment regimens can tolerate the adverse reactions, can be used as the consolidation of intensive treatment of high-risk ALL.