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目的:高白细胞急性白血病(HLAL)进展迅速,早期死亡率极高。本文观察标准诱导化疗前治疗方法———低剂量EA降低患者体内白血病细胞负荷的疗效。方法:收集2007年6月-2009年11月住院HLAL患者42例,同时以同期398例非HLAL作为对照。经血液学和骨髓检查确诊为急性髓细胞白血病(AML)28例,急性淋巴细胞白血病(ALL)14例。36例(包括所有ALL患者)诊断明确后立即给予低剂量EA诱导化疗前治疗以降低白血病细胞,6例先采用羟基脲,但效果欠佳,后换用低剂量EA方案。应用低剂量EA后,白细胞降至40×109/L以下时,采用标准MA、HA、DA或VDCLP方案诱导缓解治疗。结果:42病例(28例AML和14例ALL)低剂量EA应用第2天开始白细胞下降明显,平均3~5 d外周血白细胞计数至40×109/L以下,1例血常规恢复后复查骨髓达完全缓解,余患者进一步诱导缓解治疗2个疗程后完全缓解率47.62%(20/42,包括全部14例ALL患者),部分缓解率28.57%(12/42),总有效率76.19%(32/42),与非HLAL组的缓解率无差别(P>0.01),化疗中无一例出现肿瘤溶解综合征。1例白细胞数>400×109/L,住院24 h内脑出血而死亡。结论:低剂量EA能迅速降低HLAL肿瘤负荷,及时改善临床症状,早期死亡率低,并且对淋巴系和髓系白血病细胞均有良好疗效,同时花费较低,为有效的HLAL诱导化疗前治疗新方法。
OBJECTIVE: HLAL is rapidly progressing with an extremely high rate of early mortality. This article observes the standard induction chemotherapy before treatment - low-dose EA to reduce the patient’s leukemia cell load in the curative effect. Methods: Forty-two patients with HLAL admitted in our hospital from June 2007 to November 2009 were enrolled. At the same time, 398 non-HLAL patients were recruited as control group. Hematology and bone marrow examination confirmed acute myeloid leukemia (AML) in 28 cases, acute lymphoblastic leukemia (ALL) in 14 cases. Thirty-six patients (including ALL patients) were given low-dose EA to induce pre-chemotherapy treatment to reduce leukemia cells. Six patients first treated with hydroxyurea, but the effect was not good and then switched to low-dose EA. With low dose of EA, leukopenia was induced to below 40 × 109 / L using standard MA, HA, DA or VDCLP regimens. Results: In the 42 cases (28 cases of AML and 14 cases of ALL), the white blood cell count decreased obviously on the 2nd day, the mean white blood cell count was less than 40 × 109 / L on average 3 ~ 5 days, and one case of bone marrow The complete remission rate was 47.62% (20/42, including all 14 ALL patients). The partial remission rate was 28.57% (12/42) and the total effective rate was 76.19% (32 / 42), no difference with the non-HLAL remission rate (P> 0.01), chemotherapy, no case of tumor lysis syndrome. One case of white blood cell count> 400 × 109 / L, died within 24 h of intracranial hemorrhage. CONCLUSIONS: Low-dose EA can rapidly reduce HLAL tumor burden, improve clinical symptoms in time, have low early mortality, and have good therapeutic effects on both lymphatic and myeloid leukemic cells with low cost, which is effective for HLAL-induced chemotherapeutic new method.