兒童急性淋巴細(xì)胞白血病的治療

1、兒童急性淋巴細(xì)胞白血病的治療兒童ALL化療：見(jiàn)下表（BFM-ALL90）表1.治療協(xié)議治療方家單一或每日劑量約定日期誘導(dǎo)協(xié)議I階段A潑尼松（口服）60mg/m2每日1-28?長(zhǎng)春新堿（IV）1.5mg/m2(最大，2mg)8,15,22,29柔紅霉素（IV）30mg/m28,15,22,29L-天門冬酰胺酶（IV）10000IU/m212,15,18,21,24,27,30?,33?氨甲蝶吟（IT）12mg?1,15,29階段B（僅限標(biāo)危組和中危組）環(huán)磷酰胺（IV）1000mg/m236,64阿糖胞甘（IV）75mg/m2perday38-41,45-48,52-55,59-626部基口嘿吟（

2、orally）60mg/m2perday36-64氨甲蝶吟（IT）12mg?45,59鞏固（在標(biāo)危組和中危組中）協(xié)議M6-疏喋吟(orally)25mg/m2perday1-56氨甲蝶吟（24-小時(shí)輸注）§5g/m28,22,36,50氨甲蝶吟（IT）12mg?8,22,36,50協(xié)議M-A?L-天門冬酰胺酶（IM）25000IU/m210,24,38,52再誘導(dǎo)（在標(biāo)危組和中危組）協(xié)議lII地塞米松（orally）10mg/m2perday1-21長(zhǎng)春新堿（IV）1.5mg/m2(max,2mg)8,15,22,29阿霉素（IV）30mg/m28,15,22,29L-天門冬酰胺酶（

3、IV）10000IU/m28,11,15,18環(huán)磷酰胺（IV）1000mg/m236阿糖胞甘（IV）75mg/m238-41,45-486-硫鳥(niǎo)喋吟（orally）60mg/m236-49氨甲蝶吟（IT）12mg?38,45強(qiáng)化再鞏固（僅限高危組）士HR-1地塞米松e（orally）20mg/m21-56-疏喋吟(orally)100mg/m2perday1-5Vincristine(IV)1.5mg/m21,5氨甲蝶吟(24-hrinf)§5g/m21阿糖胞昔(3-hrinf)2g/m2(singledose)5(twice,12-hrinterval)L-天門冬酰胺酶(IM)25

4、000IU/m26氨甲蝶吟/阿糖胞昔/潑尼松龍(IT)12mg/30mg/10mg?1要素HR-2地塞米松(orally)20mg/m21-5硫鳥(niǎo)喋吟(orally)100mg/m2perday1-5長(zhǎng)春地辛(IV)3mg/m21氨甲蝶吟(24-hrinf)§5g/m21異環(huán)磷酰胺(1-hrinf)400mg/m2perday1-5柔紅霉素(24-hrinf)50mg/m25L-天門冬酰胺酶(IM)25000IU/m26氨甲蝶吟/阿糖胞甘/潑尼松龍(IT)12mg/30mg/10mg?1要素HR-3地塞米松(orally)20mg/m21-5阿糖胞昔(3-hrinf)2g/m2(si

5、ngledose)1,2(4times,12-hrnterval)足葉乙莉(1-hrinf)150mg/m2perday3-5L-天門冬酰胺酶(IM)25000IU/m26氨甲蝶吟/阿糖胞昔/潑尼松龍(IT)12mg/30mg/10mg?5IV指的是靜注；max,最多；IT,intrathecal;SRG,標(biāo)危組；MRG,中危組；inf,輸注；IM,肌注；HRG,高危組.對(duì)于誘導(dǎo)、鞏固和再誘導(dǎo)，約定的日期是治療的時(shí)間順序，如果臨床條件和骨髓恢復(fù)不充分，允許調(diào)整及時(shí)調(diào)整時(shí)間表(根據(jù)協(xié)議指南)。對(duì)于強(qiáng)化再鞏固，約定的日期是每周期應(yīng)用的天數(shù)，除非有別的指征，每周期進(jìn)行3次。?在高危組中，協(xié)議I階段A

6、中強(qiáng)的松只用21天和6次L-門冬酰胺酶。?3歲以下兒童調(diào)整劑量.§約定的靜注亞葉酸解救于42h時(shí)30mg/m2(or15mg/m2,seetext)及48h、54h分別給15mg/m2。?僅中危組隨機(jī)分組的病人另外接受L-門冬酰胺酶治療(在鞏固期間采用大劑量MTX后54小時(shí)開(kāi)始，4次)。BFM-RF=0.2xlog(bloodblasts/L+1)葉0.06xliversizeincentimetersbelowthecostalmargin+0.04xspleensizeincentimetersbelowthecostalmargin.用比aups|INDUCTION酬帆網(wǎng)叫間4

7、1即eom|XgmN棉(W"sr；時(shí)破Wfj|I；FI1M|IIIF*土善郡MR：用R.而，mfftlOf»I'ALUorHR:*PBK«*NRui?Ji,fw*pmL:l.I一:IER$一一HE:一M一H;_一HK二HM1inHRfwjcJcctccindiuiicnWeeksII5H21嘉301皿FiguntTreatmentintnlALL-BFM90rSRGin(底爆shndankMgioupcMRGmediamisk7oup;andHRG.high-riskgroup.DetailiontiestirKntelemaitiI.M.MAII,HR-1,HR-2,andHR-3are班nriTable1,AsteriskiiiJcjIts忙prevertNcradiedhenpvHpatientunder1yearolz驊patientswithcenlralnerwussyslaniwohementreceivedno陌l(fā)ialioiiheywereunderJyardage,18Gyiflheywereciderthan1yearofmstxiunder2yearsdage.and24Gjiflheywere2yearscfogetroiier.學(xué)習(xí)是成就事業(yè)的基石BFM-R