对61例存活5年以上的小儿急性淋巴细胞白血病(ALL)患儿进行分析，探讨影响其长期存活的因素。

对这61例ALL患儿通过骨髓形态分型、免疫分型、染色体核型分析(MIC)、临床分型和微量残留病(MRD)检测，以及通过不同时期3组化疗方案及4种髓外白血病防治方法比较，了解其对疗效及预后的影响。

61例5年以上存活ALL患儿与176例5年以下存活患儿比较，二者染色体差异有显著意义(P = 0. 007)，临床分型、骨髓形态分型及免疫分型比较差异无显著意义(P>0.05)。61例5年以上存活的ALL患儿中，不同时期3组治疗方案无病存活率比较，VCP（长春新碱、环磷酰胺、强的松）组与VDLP(长春新碱、柔红霉素、L-门冬酰胺酶、强的松)组间差异有显著意义(P=0. 010)。采用⁶⁰Co头颅照射为主的治疗方案，3例发生中枢神经系统白血病(CNSL)，采用大剂量氨甲碟呤(HDMTX)防治组，无CNSL发生，5例发生睾丸白血病(TL)的患儿均系⁶⁰Co头颅照射组，HDMTX组无TL发生(P=0. 000)。61例5年以上存活ALL患儿中，25例已存活10年以上，现仍然存活，另36例存活5至10年者中，有5例死于骨髓复发，这两者骨髓复发的差异无显著意义(χ² = 3. 78，P=0. 072)。纳入本研究的所有ALL患儿中，26例MRD检测呈阳性，其中14例化疗停止时已转为阴性，13例仍长期存活；12例停止化疗后MRD呈弱阳性者，其中7例长期存活。

系统规范化疗，是ALL患儿长期存活的关键，骨髓复发、髓外白血病是影响存活的重要因素。MRD转阴，可以作为患儿停止化疗的重要参考指标。

To explore factors effecting long-term survival of patients with acute lymphoblastic leukemia (ALL).

61 ALL patients with long-term survival and 176 ALL cases with under 5 years survival had been determined, before treatment, for bone marrow morphological, immunological, and chromosomal (MIC) types, and for clinical type and minimal resident disease (MRD)as well. 3 chemotherapy regimens and 4 preventive methods for extramedullary leukemia infiltration were adopted in different periods. Treatment effects and prognosis were compared according to their respective types.

① MIC type and clinical type analysis : compared with the 176 cases survived less than 5years, the 61 cases with over 5 years survival had significant difference in chromosomal type (P<0.01), but no significant difference in clinical type, bone marrow morphological type, and immunological type (P>0. 05).② Treatment methods analysis : among the 61 over 5 years survival cases, patients with VDLP regimen from year 1992 to 1999 had higher disease-free survival rate than patients with VP regimen from year 1980 to 1984 (P<0. 05), and also higher than patients with VCP regimen from year 1985 to 1991 (P<0. 05). And VDLP group had lower death rate than VP group (P<0. 05).③Prevention and treatment of extramedullary leukemia infiltration : in the two groups mainly adopting head 60Co radiotherapy, 3cases occurred central nerve system leukemia (CNSL) , and no CNSL occurred in the group receiving high dose MTX (HDMTX)(P<0. 01). And 5 cases developed testical leukemia (TL) in group with head 60Co radiotherapy, and no TL cases in the group with HDMTX (P<0. 001).④The relationship between bone marrow relapse and survival time : 25 cases who have survived over 10 years are still alive, and there were5 cases died of bone marrow relapse after surviving for 5 to 10 years (P <0. 05).⑤ MRD dynamic quantitative determination: among the 26 cases with positive MRD, 13 cases turned negative upon treatment termination, and are still alive, 12 cases tested weakly positive upon treatment termination, among them, 7 cases survived over 5 years up to now.

Systemic and standard chemotherapy is essential to enable long-term survival of ALL patients. Bone marrow relapse and extramedullary leukemia infiltration are important factors adversely affecting long-term survival. MRD turning negative from positive may serve as a referential index for the termination of treatment.