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目的 分析儿童少年急性白血病 (AL)髓外浸润临床特点 ,指导临床治疗 ,提高长期生存率。方法 回顾性分析 4 97例儿童少年AL ,为 1 996年 5月～ 2 0 0 3年 5月我院初诊住院的急性白血病患儿。结果 1 7岁以下儿童少年AL中 ,ALL占 6 3% ,ANLL 33%。ALL初诊者髓外浸润中以纵隔浸润最多见 ,并多见于T -ALL患儿。髓外浸润在ALL高危组中的发生率最高。ANLL初诊时的髓外浸润常见部位为CNS、皮肤、眼部、胸膜等 ,多发生于M2b、M4 和M5型患儿。初诊时CNS浸润ANLL比ALL常见 ,中位年龄 1 2岁 ,男性高白细胞者多发 ,发生CNS浸润最常见的是M2b型 ,均有染色体t( 8;2 1 )异常。治疗中髓外复发主要在ALL患儿的CNSL ,发病率 1 4 .5%。结论儿童少年AL髓外浸润多见于T -ALL及M2b患儿 ,与预后不良有关。早期发现 ,积极治疗 ,可降低儿童少年AL的CNSL发病率。
Objective To analyze the clinical features of acute leukemia (AL) extramedullary infiltration in children and adolescents, to guide the clinical treatment and improve the long-term survival rate. Methods A retrospective analysis of 4 97 cases of children and adolescents AL, May 1996 ~ February 2003 hospitalized newly diagnosed acute leukemia in our hospital. RESULTS: Among AL children and adolescents under 7 years of age, ALL accounted for 63% and ANLL 33%. ALL newly diagnosed extramedullary infiltration in mediastinal infiltration most common, and more common in T -ALL children. Extramedullary infiltration in ALL high-risk group the highest incidence. Extracapsular extramedullary antecedents of ANLL common parts of the CNS, skin, eye, pleura, etc., occurred in M2b, M4 and M5-type children. The CNS infiltration ANLL was more common than ALL at the first visit, with a median age of 12 years. Men with high white blood cell count were the most frequent. The most common type of CNS infiltration was type M2b, both of which had chromosomal abnormalities (8; 21). Treatment of extramedullary relapse in children with ALL mainly CNSL, the incidence of 14.5%. Conclusions Infant extramedullary infiltrates in children and adolescents are more common in children with T-ALL and M2b and are associated with poor prognosis. Early detection and aggressive treatment can reduce the incidence of CNSL in children and adolescents.