儿童急性淋巴细胞白血病的治疗

儿童急性淋巴细胞白血病的治疗儿童ALL化疗:见下表(BFM-ALL90)表1.治疗协议治疗方案单一或每日剂量约定日期诱导协议I阶段A泼尼松(口服)60mg/m2每日1-28†长春新碱(IV)1.5mg/m2(最大,2mg)8,15,22,29柔红霉素(IV)30mg/m28,15,22,29L-天门冬酰胺酶(IV)10000IU/m212,15,18,21,24,27,30†,33†氨甲蝶呤(IT)12mg‡1,15,29阶段B(仅限标危组和中危组)环磷酰胺(IV)1000mg/m236,64阿糖胞苷(IV)75mg/m2perday38-41,45-48,52-55,59-626巯基嘌呤(orally)60mg/m2perday36-64氨甲蝶呤(IT)12mg‡45,59巩固(在标危组和中危组中)协议M6-巯嘌呤(orally)25mg/m2perday1-56氨甲蝶呤(24-小时输注)§5g/m28,22,36,50氨甲蝶呤(IT)12mg‡8,22,36,50协议M-A¶L-天门冬酰胺酶(IM)25000IU/m210,24,38,52再诱导(在标危组和中危组)协议lII地塞米松(orally)10mg/m2perday1-21长春新碱(IV)1.5mg/m2(max,2mg)8,15,22,29阿霉素(IV)30mg/m28,15,22,29L-天门冬酰胺酶(IV)10000IU/m28,11,15,18环磷酰胺(IV)1000mg/m236阿糖胞苷(IV)75mg/m238-41,45-486-硫鸟嘌呤(orally)60mg/m236-49氨甲蝶呤(IT)12mg‡38,45强化再巩固(仅限高危组)要素HR-1地塞米松e(orally)20mg/m21-56-巯嘌呤(orally)100mg/m2perday1-5Vincristine(IV)1.5mg/m21,5氨甲蝶呤(24-hrinf)§5g/m21阿糖胞苷(3-hrinf)2g/m2(singledose)5(twice,12-hrinterval)L-天门冬酰胺酶(IM)25000IU/m26氨甲蝶呤/阿糖胞苷/泼尼松龙(IT)12mg/30mg/10mg‡1要素HR-2地塞米松(orally)20mg/m21-5硫鸟嘌呤(orally)100mg/m2perday1-5长春地辛(IV)3mg/m21氨甲蝶呤(24-hrinf)§5g/m21异环磷酰胺(1-hrinf)400mg/m2perday1-5柔红霉素(24-hrinf)50mg/m25L-天门冬酰胺酶(IM)25000IU/m26氨甲蝶呤/阿糖胞苷/泼尼松龙(IT)12mg/30mg/10mg‡1要素HR-3地塞米松(orally)20mg/m21-5阿糖胞苷(3-hrinf)2g/m2(singledose)1,2(4times,12-hrnterval)足叶乙甙(1-hrinf)150mg/m2perday3-5L-天门冬酰胺酶(IM)25000IU/m26氨甲蝶呤/阿糖胞苷/泼尼松龙(IT)12mg/30mg/10mg‡5IV指的是静注;max,最多;IT,intrathecal;SRG,标危组;MRG,中危组;inf,输注;IM,肌注;HRG,高危组.对于诱导、巩固和再诱导，约定的日期是治疗的时间顺序，如果临床条件和骨髓恢复不充分，允许调整及时调整时间表(根据协议指南)。对于强化再巩固，约定的日期是每周期应用的天数，除非有别的指征，每周期进行3次。†在高危组中，协议I阶段A中强的松只用21天和6次L-门冬酰胺酶。‡3岁以下儿童调整剂量.§约定的静注亚叶酸解救于42h时30mg/m2(or15mg/m2,seetext)及48h、54h分别给15mg/m2。¶仅中危组随机分组的病人另外接受L-门冬酰胺酶治疗(在巩固期间采用大剂量MTX后54小时开始，4次)。BFM-RF=0.2×log(bloodblasts/µL+1)+0.06×liversizeincentimetersbelowthecostalmargin+0.04×spleensizeincentimetersbelowthecostalmargin.BFM-RF=0.2×log(bloodblasts/µL+1)+0.06×liversizeincentimetersbelowthecostalmargin+0.04×spleensizeincentimetersbelowthecostalmargin.