Chu H Y, Shu S G, Law K L, Chi C S
Department of Pediatrics, Taichung Veterans General Hospital, Taiwan, R.O.C.
Zhonghua Min Guo Xiao Er Ke Yi Xue Hui Za Zhi. 1993 Mar-Apr;34(2):118-24.
Between August 1984 and September 1990, 13 children with non-Hodgkin's lymphoma (NHL) were treated with ALL high-risk protocol (5 with TCLSG 842 regimen and 8 with TPOG 882B protocol) at Taichung Veterans General Hospital. Diagnosis of NHL was confirmed by histology. Nine had lymphoblastic lymphoma, three had histiocytic lymphoma and one had small non-cleaved cell lymphoma, according to the Rappaport classification. After thorough clinical evaluation eight children were NHL stage IV; four were stage III; and one was stage II. All these children had received chemotherapy as acute lymphocytic leukemia (ALL) high-risk protocol for a total of three years, including central nervous system (CNS) prophylaxis. Of the 13 patients, 9 (69.2%) gained complete remission. Over-all survival rate was 46.2%, with a median interval of 36 months. The complete remission rate and survival rate for the nine children with lymphoblastic lymphoma was better at 77.7% & 66.6% respectively. Within the nonresponsive group, two failed to remit because of early withdrawal from the protocol; the other two patients were refractory to treatment. Relapse was noted in one patient. As to the side effects, neutropenic fever was the most common problem encountered (9 occurrences in 13 patients). Other major complications included severe mucositis, massive GI bleeding, intracranial thrombosis induced by l-asparaginase and tumor lysis syndrome. Childhood NHL is often of diffuse types in pathology, and most affected children have advanced diseases at diagnosis. Choosing an optimal treatment protocol is important for good treatment results.
1984年8月至1990年9月期间，台中荣民总医院对13例非霍奇金淋巴瘤（NHL）患儿采用急性淋巴细胞白血病（ALL）高危方案进行治疗（5例采用TCLSG 842方案，8例采用TPOG 882B方案）。NHL的诊断经组织学证实。根据Rappaport分类，9例为淋巴母细胞淋巴瘤，3例为组织细胞淋巴瘤，1例为小无裂细胞淋巴瘤。经过全面的临床评估，8例患儿为NHL Ⅳ期；4例为Ⅲ期；1例为Ⅱ期。所有这些患儿均接受了为期三年的ALL高危方案化疗，包括中枢神经系统（CNS）预防。13例患者中，9例（69.2%）获得完全缓解。总生存率为46.2%，中位生存期为36个月。9例淋巴母细胞淋巴瘤患儿的完全缓解率和生存率分别较好，为77.7%和66.6%。在无反应组中，2例因提前退出方案而未能缓解；另外2例患者对治疗耐药。1例患者出现复发。至于副作用，中性粒细胞减少性发热是最常见的问题（13例患者中有9例发生）。其他主要并发症包括严重的粘膜炎、大量胃肠道出血、左旋门冬酰胺酶诱导的颅内血栓形成和肿瘤溶解综合征。儿童NHL在病理上常为弥漫型，大多数患病儿童在诊断时已处于晚期。选择最佳治疗方案对取得良好的治疗效果很重要。
