小兒急性白血病之長期生存例

Long-Term Survivors of Acute Leukemia in Childhood

林國信(Kuo-Sin Lin) ； 陳德輝(Tou-Hwei Chen) ； 林禎輝(Chen-Hui Liu)

《Acta Paediatrica Sinica》 16卷2期 (1975/06) Pp. 51-61

摘要

長期生存的小兒白血病病例在國內尚屬罕見。台大醫院小兒科十年來共有6個生在期間超過5年的急性白血病病例。其中5例為急性淋巴性白血病，1例為急性骨髓性白血病。5名為男孩，1名為女孩。初診時年齡在3歲7個月至8歲11個月之間。其中3例一直不曾再發，3例已經死亡（包括急性骨髓性白血病之一例）。生在期間最短在5年1個月以上。最長的超過8年。死亡的3例中。2例死於敗血症，1例死於大出血：2例曾有明顯的腦膜白血病，1例有可疑的中樞神經症狀。仍然生存的3例中則有1例曾患水痘，另有1例曾因肝硬化症住院。文獻上通常以年齡在3至10歲之間，治療前白血球數在20000/mm^3以下，沒有嚴重的出血傾向或組織浸潤，白血病細胞屬於淋巴球系等為長期生存的有利條件。我們的6例並不完全符合這些條件。腫瘍細胞對藥物的感受性。病人本身的免疫機能，合併症的預防與治療。以及治療的細節等可能對生存期間都有重要的影響。如果『不因疾病或治療本身引起痛苦就是痊癒』，至少我們已經有了3個5至8年來健康地生活著的白血病兒童。假以時日，相信會有多「痊癒」的病例。

並列摘要

The authors report six cases of acute leukemia in childhood with survival time of more than 5 years after the establishment of diagnosis in the National Taiwan University Hospital. Of the six cases, five were male and one female. Five had acute lymphogenous leukemia (ALL), and one had acute myelogenous leukemia (AML). The youngest patient was 3 years and 7 months of age and the oldest one was 8 years and 11 months at the time of diagnosis.
For ALL cases, prednisolone and 6-mercatopurine were used in combination for the induction of remission. On the other hand, for the AML case, various combination of intravenous administration of methotrexate, cytosine arabinoside in addition to the above-mentioned two regimens were used as inducer regimens. All cases were mostly maintained with oral use of 6-mercaptopurine and methotrexate two to three months alternately. Three of five ALL patients are still alive at present time. They have survived 8 years, 56/12 years, and 52/12 years, respectively, since the diagnosis was made. They also had no record of relapse. One of the two ALL cases died of infection and the other o bleeding. The only one AML case died of overwhelming E. coli sepsis during the fourth time of relapse.
The literature was reviewed and the possible factors concerning the long-time survival were discussed. We believe that with improved care, the number of long-term survivors in childhood acute leukemia will be much more increased.