Clinical observation of Cytarabine combined with VDLD induction therapy for children with relapsed/refractory acute lymphoblastic leukemia

目的 观察阿糖胞苷联合VDLD(长春地辛、地塞米松、培门冬酶、去甲氧柔红霉素)诱导治疗儿童难治/复发急性淋巴细胞白血病的有效性及安全性.方法 选取2015年9月～2016年5月首都儿科研究所附属儿童医院血液科诊治的6例难治/复发急性淋巴细胞白血病患儿为研究对象,进行多药联合诱导治疗,其中,阿糖胞苷(Ara-C)75 mg/(m2·d),静脉滴注,第8～14天;去甲氧柔红霉素5～6 mg/(m2·d),静脉滴注,第8、9天;长春地辛、地塞米松、培门冬酶剂量参考CCLG-2008急性淋巴细胞白血病诱导缓解治疗方案,诱导治疗第33天通过复查骨髓细胞形态、流式细胞术检测残留病变(MRD)评估疗效.结果 6例患儿全部获得完全缓解,1例最终因颅内真菌感染死亡.所有患儿均出现Ⅳ度造血功能受抑,6例患儿均未出现严重的脏器功能受损.结论 阿糖胞苷联合VDLD案对儿童难治/复发急性淋巴细胞白血病诱导治疗效果好,但感染风险较高,在有效的抗感染护理及治疗下,可以作为部分儿童难治/复发急性淋巴细胞白血病诱导治疗的一种新的有效方法.Objective To observe the efficacy and safety of therapy protocol which combining Cytarabine with VDLD (Vindesine,Dexamethasone,Pegaspargase and Idarubicin) for childen with relapsed/refractory acute lymphoblastic leukemia.Methods 6 cases of patients with relapsed/refractory acute lymphoblastic leukemia treated in Hematological Department,Children's Hospital,Capital Institute of Pediatrics were selected as research objects from September 2015 to May 2016.All children were given multi-drug combined induction therapy,including Cytarabine (Ara-C) 75 mg/(m2·d),intravenous drip,d8-14;Idarubincin 5-6 mg/(m2 ·d),intravenous drip,d8,d9;Vindesine,Dexamethasone,Pegasgase dosage reference CCLG-2008 acute lymphoblastic leukemia alleviate induction therapy.The curative effects were evaluated on the induction therapy 33rd day,through the review of the marrow cell morphology and residual disease (MRD) detection by flowcytometry.Results All 6 children received complete remission,but 1 case finally died in intracranial fungal infection.All cases appeared IV degree of hematopoiesis inhibition.All 6 cases were not had severe viscera function injury.Conclusion Cytarabine combined with VDLD induction therapy for children with relapsed/refractory acute lymphoblastic leukemia has good effect,but the risk of infection is higher,under the effective anti-infection nursing and treatment,it can be used as a new effective treatment method for parts of children with relapsed/refractory acute lymphoblastic leukemia.571-741