地塞米松与泼尼松诱导缓解治疗中高危ALL患儿的效果比较OA
Comparison on the Efficacy of Remission Induction with Dexamethasone and Prednisone in Children with Moderately and High-risk ALL
目的:比较地塞米松与泼尼松诱导缓解治疗中高危急性淋巴细胞白血病(ALL)患儿的效果.方法:选择江西省儿童医院在 2021 年 6 月—2023 年 6 月收治的初始危险度为中高危的 ALL 患儿 120 例,使用随机数字表法分为对照组和研究组,各 60 例.所有患儿在治疗窗口期,治疗第 1～4 天口服地塞米松,对照组患儿于诱导缓解期接受 PVDL 方案(泼尼松+长春新碱+柔红霉素+门冬酰胺酶),研究组将对照组方案中的泼尼松替换为地塞米松,其余与对照组相同.比较两组 2 年的无事件生存(EFS)率、总生存(OS)率、治疗有效性和安全性.结果:截至末次随访日期,研究组患儿2 例放弃,5 例患儿复发或死亡,对照组患儿 3 例转院或放弃,14 例患儿复发或死亡.研究组患儿中2 年 OS 率 88.3%[95%CI(80.1%,96.5%)]、2 年 EFS 率 78.3%[95%CI(67.9%,88.7%)]高于对照组的70.7%[95%CI(58.5%,82.9%)]、58.3%[95%CI(45.8%,70.8%)](P<0.05);研究组患儿的完全缓解率(88.33%)高于对照组(73.33%)(P<0.05),研究组患儿第 19 天微小残留病(MRD)阴性率(51.67%)与对照组(43.33%)比较,差异无统计学意义(P>0.05),研究组患儿第 46 天 MRD 阴性率(89.47%)高于对照组(72.41%)(P<0.05);两组患儿治疗安全性比较,差异无统计学意义(P>0.05).结论:相较于泼尼松,8 mg/(m2·d)地塞米松可显著提升中高危 ALL 患儿 2 年 EFS 率与 OS 率,不会增加明显的毒副作用,具有良好的治疗有效性和安全性.
Objective:To compare the efficacy of remission induction with Dexamethasone and Prednisone in children with moderately high-risk acute lymphoblastic leukaemia(ALL).Method:A total of 120 children with moderately high-risk ALL admitted to Jiangxi Provincial Children's Hospital were enrolled from June 2021 to June 2023.According to random number table method,they were divided into control group and study group,60 cases in each group.In treatment window phase,all children were given oral Dexamethasone from 1st-4th day after treatment,control group was given PVDL regimen(Prednisone+Vincristine+Daunorubicin+L-asparaginasum)during remission induction,the study group replaced Prednisone with Dexamethasone in the control group protocol,while the rest remained the same as the control group.The 2-year event-free survival(EFS)rate,overall survival(OS)rate,treatment effectiveness and safety were compared between the two groups.Result:As of the last follow-up,there were 2 cases giving up and 5 cases with recurrence or death in study group,while there were 3 cases transferred or giving up,14 cases with recurrence or death in control group.The 2-year OS rate 88.3%[95%CI(80.1%,96.5%)]and 2-year EFS rate 78.3%[95%CI(67.9%,88.7%)]in study group were higher than 70.7%[95%CI(58.5%,82.9%)],58.3%[95%CI(45.8%,70.8%)]in control group(P<0.05).The complete remission rate in study group(88.33%)was higher than that in control group(73.33%)(P<0.05).There was no significant difference in negative rate of minimal residual disease(MRD)on the 19th day between study group(51.67%)and control group(43.33%)(P>0.05),but negative rate of MRD on the 46th day in study group(89.47%)was higher than that in control group(72.41%)(P<0.05).There was no significant difference in treatment safety between the two groups(P>0.05).Conclusion:Compared with Prednisone,8 mg/(m2·d)Dexamethasone can significantly increase 2-year EFS rate and OS rate,and will not increase obvious side effects,and demonstrates good therapeutic efficacy and safety.
范小菊;李艳红;李争;冯小燕
江西省儿童医院血液一科 江西 南昌 330038江西省儿童医院中医科 江西 南昌 330038江西省儿童医院血液一科 江西 南昌 330038江西省儿童医院血液一科 江西 南昌 330038
医药卫生
急性淋巴细胞白血病儿童地塞米松泼尼松
Acute lymphoblastic leukemiaChildDexamethasonePrednisone
《中国医学创新》 2026 (24)
17-21,5
江西省卫生健康委科技计划项目(202311038)
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