Nghiên cứu kết quả điều trị u lympho ác tính không Hodgkin ở trẻ em giai đoạn III+IV bằng phác đồ NHL – BFM 90 tại bệnh viện K

Header Page of 161 B GIO DC V O TO B Y T TRNG I HC Y H NI PHM TH VIT HNG NGHIÊN CứU KếT QUả ĐIềU TRị U LYMPHO áC TíNH KHÔNG HODGKIN TRẻ EM GIAI ĐOạN III+IV BằNG PHáC Đồ NHL - BFM 90 TạI BệNH VIệN K LUN N TIN S Y HC H NI - 2016 Footer Page of 161 Header Page of 161 B GIO DC V O TO B Y T TRNG I HC Y H NI PHM TH VIT HNG NGHIÊN CứU KếT QUả ĐIềU TRị U LYMPHO áC TíNH KHÔNG HODGKIN TRẻ EM GIAI ĐOạN III+IV BằNG PHáC Đồ NHL - BFM 90 TạI BệNH VIệN K Chuyờn ngnh : Ung th Mó s : 62720149 LUN N TIN S Y HC Ngi hng dn khoa hc: PGS TS Phm Duy Hin H NI - 2016 Footer Page of 161 Header Page of 161 LI CM N Trong quỏ trỡnh thc hin v hon thnh lun ỏn tin s, tụi xin trõn trng cm n: ng y, Ban giỏm hiu, Phũng qun lý o to Sau i hc, B mụn Ung th Trng i hc Y H Ni Ban giỏm c Bnh vin K, Phũng k hoch tng hp, khoa gii phu bnh t bo cựng cỏc khoa phũng bnh vin K Ch nhim b mụn Ung th Trng i hc Y H Ni PGS.TS Lờ Vn Qung, nguyờn ch nhim b mụn ung th PGS.TS Nguyn Vn Hiu Tụi xin by t lũng bit n ti PGS TS Phm Duy Hin, l ngi Thy ó hng dn khoa hc v tn tỡnh ch bo tụi ton b quỏ trỡnh nghiờn cu v hon thnh lun ỏn ny ng thi, tụi cng xin trõn trng cm n cỏc Thy Cụ B mụn Ung th Trng i hc Y H Ni ó to mi iu kin thun li v truyn t kin thc cho tụi quỏ trỡnh hc Tụi cng chõn thnh cm n cỏc anh ch em bỏc s, bn bố ó luụn bờn v h tr tụi quỏ trỡnh hon thnh lun ỏn c bit tụi xin kớnh trng by t lũng bit n sõu sc ti B, M v gia ỡnh ó luụn ng h, ng viờn tụi hc tp, phn u v trng thnh cuc sng v s nghip Xin trõn trng cm n! H Ni, ngy 20 thỏng nm 2016 Tỏc gi lun ỏn Phm Th Vit Hng Footer Page of 161 Header Page of 161 LI CAM OAN Tụi l Phm Th Vit Hng, nghiờn cu sinh khúa 29 Trng i hc Y H Ni, chuyờn ngnh ung th, xin cam oan: õy l lun ỏn bn thõn tụi trc tip thc hin di s hng dn ca Thy PGS TS Phm Duy Hin Cụng trỡnh ny khụng trựng lp vi bt k nghiờn cu no khỏc ó c cụng b ti Vit Nam Cỏc s liu v thụng tin nghiờn cu l hon ton chớnh xỏc, trung thc v khỏch quan, ó c xỏc nhn v chp thun ca c s ni nghiờn cu Tụi xin hon ton chu trỏch nhim trc phỏp lut v nhng cam kt ny H Ni, ngy 20 thỏng nm 2016 Tỏc gi lun ỏn Phm Th Vit Hng Footer Page of 161 Header Page of 161 CC CH VIT TT TRONG LUN N BC, BCTT, TC : Bch cu, bch cu trung tớnh, tiu cu BN : Bnh nhi CD : (Cluster of differentiation) Cm bit húa cs : Cng s HT, MP : ỏp ng hon ton, ỏp ng mt phn g/l : Gram/lớt G/l : Giga/lớt Hb : Hemoglobin LDH : Lactat Dehydrogenase MBH : Mụ bnh hc mg/l : Miligram/lớt mg/m2 : Milligram/một vuụng din tớch da c th NHL - BFM 90 : Non-Hodgkins Lymphoma Berlin-Frankfurt-Mỹnster 90 SGOT/ SGPT : Serum Glutamat Oxalat/Pyruvat Transaminase STKB, STTB : Sng thờm khụng bnh, sng thờm ton b TKTW : Thn kinh trung ng TM : Truyn tnh mch ngoi vi U/L : n v/Lớt ULAKH : U lympho ỏc tớnh khụng Hodgkin WF 1982 : Working Formulation 1982 WHO : World Health Organization: T chc Y t Th gii Footer Page of 161 Header Page of 161 MC LC T VN Chng 1: TNG QUAN TI LIU 1.1 Mt s c im dch t ULAKH tr em 1.1.1 T l mc bnh 1.1.2 Tui 1.1.3 Gii 1.1.4 Vựng a lý v chng tc 1.2 Mt s yu t nguy c 1.2.1 Cỏc yu t di truyn v t bin gen 1.2.2 Suy gim dch bm sinh hoc mc phi 1.2.3 Cỏc virus, vi khun 1.3 c im lõm sng 1.3.1 Triu chng ton thõn 1.3.2 Triu chng thc th 1.4 Giai on bnh 11 1.5 c im MBH 12 1.6 c im dch ngun gc t bo 17 1.7 iu tr ULAKH tr em 17 1.7.1 Nguyờn tc chung 17 1.7.2 Vai trũ ca cỏc phng phỏp iu tr 17 1.8 iu tr ULAKH tr em tỏi phỏt 33 1.9 iu tr ớch ULAKH tr em 34 1.10 iu tr mt s th c bit 37 1.10.1 ULAKH nguyờn phỏt h TKTW 37 1.10.2 ULAKH th MALT tr em 37 1.11 Ghộp t bo gc to mỏu 38 Footer Page of 161 Header Page of 161 Chng 2: I TNG V PHNG PHP NGHIấN CU 39 2.1 i tng nghiờn cu 39 2.1.1 Tiờu chun la chn 39 2.1.2 Tiờu chun loi tr 39 2.2 Phng phỏp nghiờn cu 39 2.2.1 Tớnh c mu 39 2.2.2 Cỏc bc tin hnh nghiờn cu 40 2.2.3 Cỏc ch tiờu ghi nhn 41 2.2.4 Phng phỏp thu thp s liu 53 2.2.5 K thut khng ch sai s 53 2.2.6 Phng phỏp x lý v phõn tớch s liu 53 2.3 o c nghiờn cu 54 2.4 a im v thi gian nghiờn cu 54 Chng 3: KT QU NGHIấN CU 56 3.1 Tui v gii 56 3.2 c im lõm sng 57 3.2.1 Lý vo vin 57 3.2.2 Thi gian bnh 58 3.2.3 Phõn b tn thng 58 3.2.4 ỏnh giỏ giai on 60 3.3 c im cn lõm sng 61 3.3.1 Phõn loi MBH v ngun gc t bo 61 3.3.2 Xột nghim tu trc iu tr 63 3.3.3 Nng LDH huyt 63 3.4 Kt qu iu tr bng phỏc NHL-BFM 90 64 3.4.1 ỏp ng sau pha tn cụng v cỏc yu t liờn quan n ỏp ng 64 3.4.2 ỏp ng hon ton sm - mun v cỏc yu t liờn quan 67 3.4.3 c tớnh liờn quan n phỏc iu tr 70 Footer Page of 161 Header Page of 161 3.4.4 Tỏi phỏt v mt s yu t liờn quan 74 3.4.5 T vong v mt s yu t liờn quan 76 3.4.6 Sng thờm vi mt s yu t liờn quan 81 Chng 4: BN LUN 92 4.1 c im v tui v gii 92 4.2 c im lõm sng 94 4.2.1 Lý vo vin 94 4.2.2 Thi gian bnh 94 4.2.3 Phõn b tn thng 95 4.2.4 nh hng ca bnh i vi ton thõn 97 4.2.5 T l giai on bnh 98 4.3 c im MBH 98 4.3.1 Phõn loi MBH theo WF 1982 98 4.3.2 Phõn loi MBH theo WHO 2001 100 4.3.3 Phõn nhúm ngun gc t bo 102 4.4 Tỡnh trng ty trc iu tr 103 4.5 Nng LDH huyt 103 4.6 Kt qu iu tr 103 4.6.1 T l HT sau pha tn cụng 103 4.6.2 c tớnh liờn quan n phỏc iu tr 106 4.6.3 Tỏi phỏt 113 4.6.4 T vong 114 4.6.5 T l STKB, STTB nm 116 KT LUN 124 KIN NGH 126 MT S CễNG TRèNH NGHIấN CU CễNG B Cể LIấN QUAN N LUN N TI LIU THAM KHO PH LC Footer Page of 161 Header Page of 161 DANH MC BNG BIU Bng 1.1 Giai on bnh ULAKH tr em theo St Jude Murphy 12 Bng 1.2 Cụng thc thc hnh phõn loi MBH ULAKH 1982 13 Bng 1.3 Phõn loi MBH ca T chc Y t th gii (2001) 14 Bng 2.1 Phõn c tớnh trờn h to huyt 49 Bng 2.2 Phõn c tớnh trờn gan, thn 50 Bng 2.3 Phõn c tớnh khỏc 50 Bng 3.1 Phõn b nhúm tui 56 Bng 3.2 T l cỏc lý vo vin 57 Bng 3.3 Thi gian bnh 58 Bng 3.4 T l cỏc v trớ tn thng 59 Bng 3.5 T l cỏc tn thng c quan ni tng 59 Bng 3.6 T l nh hng ton thõn 60 Bng 3.7 T l th MBH theo phõn loi WF 1982 61 Bng 3.8 T l MBH theo WHO 2001 62 Bng 3.9 T l phõn loi ngun gc t bo 62 Bng 3.10 T l LDH huyt tng 63 Bng 3.11 T l ỏp ng sau pha tn cụng 64 Bng 3.12 T l HT theo la tui 65 Bng 3.13 T l HT theo thi gian bnh 65 Bng 3.14 T l HT theo LDH huyt 66 Bng 3.15 T l HT theo th MBH 66 Bng 3.16 T l HT sm - mun 67 Bng 3.17 T l HT sm - mun theo gii 67 Bng 3.18 T l HT sm - mun theo la tui 68 Bng 3.19 T l HT sm - mun theo thi gian bnh 68 Footer Page of 161 Header Page 10 of 161 Bng 3.20 T l HT sm - mun theo LDH huyt 69 Bng 3.21 T l HT sm - mun theo MBH (phõn loi WHO 2001) 69 Bng 3.22 T l c tớnh trờn h to huyt 70 Bng 3.23 T l c tớnh trờn gan thn 72 Bng 3.24 T l mt s tỏc dng ph khụng mong mun khỏc 73 Bng 3.25 T l tỏi phỏt liờn quan n nng LDH huyt 75 Bng 3.26 T l t vong theo gii 77 Bng 3.27 T l t vong theo nhúm tui 77 Bng 3.28 T l t vong liờn quan n thi gian bnh 78 Bng 3.29 T l t vong liờn quan n giai on 78 Bng 3.30 T l t vong liờn quan n HT sm mun 79 Bng 3.31 T l t vong liờn quan n LDH huyt 79 Bng 4.1 So sỏnh tui trung bỡnh vi cỏc nghiờn cu khỏc 92 Bng 4.2 So sỏnh t l nam/n vi cỏc nghiờn cu khỏc 93 Bng 4.3 So sỏnh t l (%) giai on bnh vi mt s nghiờn cu 98 Bng 4.4 So sỏnh t l ngun gc t bo theo mt s tỏc gi 102 Bng 4.5 So sỏnh t l HT sau pha tn cụng gia cỏc nghiờn cu 104 Bng 4.6 So sỏnh t l STKB, STTB nm vi mt s nghiờn cu 117 Footer Page 10 of 161 Header Page 151 of 161 95 Reiter A, Schrappe M et al (2000) Intensive ALL-type therapy without local radiotherapy provides a 90% event-free survival for children with T-cell lymphoblastic lymphoma: a BFM group report Blood 2000; 95:416 96 Attarbaschi A, Mann G et al (2002) Malignant non-Hodgkin's lymphoma of childhood and adolescence in Austria therapy results between 1986 and 2000 Wien Klin Wochenschr 2002 Dec 30;114(2324):978-86 97 Sun XF, Zhen ZJ et al (2007) Efficacy of modified B-NHL-BFM 90 protocol on Burkitts lymphoma in Chinese children and adolescents, Ai Zheng, 2007 Dec; 26(12), 1339-1343 98 Karadeniz C et al (2007) Clinical characteristics and treatment results of pediatric B-cell non-Hodgkins lymphoma patients in a single center Pediatr Hematol Oncol 2007 Sep; 24(6): 417-30 99 Mỹller J, Csúka M et al (2008) Treatment of pediatric non-Hodgkin lymphoma in Hungary: 15 years experience with NHL-BFM 90 and 95 protocols Pediatr Blood Cancer 2008 Mar;50(3):633-5 100 Fukano R, Suminoe A et al (2012) Treatment outcome of non-Hodgkin lymphoma in childhood: KYCCSG NHL-89, 96 Rinsho Ketsueki 2012 Nov;53(11):1898-905 101 Meng JH et al (2012) Comparison of the efficacy of CCCG-97 and BFM-90 protocols in the treatment for children with mature B-cell nonHodgkin's lymphoma Zhonghua Zhong Liu Za Zhi 2012 Mar; 34(3): 222-7 102 Chen Y, Sun XF et al (2013) Germinal-center type B-cell classification and clinical 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according to the World Health Organization classification Indian J Cancer 2011 Oct-Dec;48(4):446-51 143 Manipadam MT, Nair S, Viswabandya A et al (2011) Non-Hodgkin lymphoma in childhood and adolescence: frequency and distribution of immunomorphological types from a tertiary care center in South India World J Pediatr 2011 Nov;7(4):318-25 Footer Page 156 of 161 Header Page 157 of 161 144 Wang J, Wu X et al (2012) Paediatric lymphoma in China: a clinicopathological study of 213 cases Pathology: December 2012 Volume 44 - Issue - p 622625 145 Wrửbel G, Kazanowska B et al (2004) Progress in the treatment of non-Hodgkin's lymphoma (NHL) in children The report of Polish Pediatric Leukaemia/lymphoma Study Group (PPLLSG) (Polish) Przegl Lek 2004; 61 Suppl 2:45-48 146 Gualco G, Weiss LM, Harrington WJ Jr, et al (2009) Nodal diffuse large B-cell lymphomas in children and adolescents: immunohistochemical expression patterns and c-MYC translocation in relation to clinical outcome Am J Surg Pathol 33 (12): 1815-22 147 Sun XF, Jiang WQ, Liu DG et al (2004) Efficacy of modified BFM-90 regimen on children and adolescents with T cell lymphoblastic lymphoma: a report of 20 cases Ai Zheng 2004 Dec;23(12):1687-91 148 Sun XF et al (2009) Efficacy of modified B-NHL-BFM-90 protocol on anaplastic T-cell lymphoma in children and adolescents Ai Zheng 2009 May;28(5):506-10 149 Jin L, Zhang R, Huang S et al (2012) Clinical features and prognosis of children with lymphoblastic lymphoma, Zhonghua Zhong Liu Za Zhi 2012 Feb;34(2):138-42 150 Zhang Yu-tong, FENG Li-hua,; Zhong Xiao-dan, et al (2014) Treatment of Children with Advanced-Stage Lymphoblastic Lymphoma with Pegaspargase, Iran J Pediatr; Vol 24 (No 1), Feb 2014, 75-80 151 Sun XF et al (2008) Intensive chemotherapy improved treatment outcome for Chinese children and adolescents with lymphoblastic lymphoma Int J Clin Oncol 2008 Oct;13(5):436-41 152 Zhen ZJ et al (2009) Prophylaxis and treatment of modified BFM-90 regimen for lymphoblastic lymphoma in children and adolescents accompanied with infection Ai Zheng 2009 Jul;28(7):718-24 Footer Page 157 of 161 Header Page 158 of 161 153 Sun XF, Zhen ZJ et al (2013) Outcome of children and adolescents with Burkitt lymphoma and diffuse large B cell lymphoma treated with a modified NHL-BFM-90 protocol Zhonghua Xue Ye Xue Za Zhi 2013 Dec;34(12):1032-7 154 Mikkelsen TS et al (2014) Extended duration of prehydration does not prevent nephrotoxicity or delayed drug elimination in high-dose methotrexate infusions: a prospectively randomized cross-over stud Pediatr Blood Cancer 2014 Feb;61(2):297-301 155 Yan Xie, Yuntao Zhang, Wen Zheng et al (2015) Outcome of doseadjusted Berlin Frankfurt Munster 90 regimen without radiotherapy in adolescents and adults with T cell lymphoblastic lymphoma, Med Oncol (2015) 32:110 156 Nina Erculj, Barbara Faganel Kotnik, Marusa Debeljak et al (2014) The influence of folate pathway polymorphisms on high-dose methotrexate-related toxicity and survival in children with nonHodgkin malignant lymphoma, Radiol Oncol 2014; 48 (3): 289-292 157 Burkhardt B, Alfred Reiter, Eva Landmann et al (2009) Poor Outcome for Children and Adolescents With Progressive Disease or Relapse of Lymphoblastic Lymphoma: A Report From the Berlin-FrankfurtMuenster Group, JCO July 10, 2009 vol 27 no 20; 3363-3369 158 Grenzebach J et al (2001) Favorable outcome for children and adolescents with T-cell lymphoblastic lymphoma with an intensive ALL-type therapy without local radiotherapy Ann Hematol 2001;80 Suppl 3:B73-6 159 Sun XF, Zhen Z, Zhu J et al (2014) Outcome of modified NHL-BFM 90 protocol for children and adolescents with lymphoblastic lymphoma, Zhonghua Zhong Liu Za Zhi, 2014 Dec; 35 (12): 1083-9 Footer Page 158 of 161 Header Page 159 of 161 PHIU THU THP THễNG TIN ULAKH TR EM S h s: I Phn hnh chớnh: H v tờn: Gii: nam1, n2 Tui: B m: T: Liờn h cn a ch: Ngy vo vin: Ngy HT: Ngy vin: Ngy t vong: Ngy phỏt hin tỏi phỏt: II Phn hi v khỏm bnh: Lý vo vin: t phỏt hin u hch tc rut lit hai chi di 2.st thiu mỏu gy sỳt khú th xut huyt tỡnh c Thi gian t lỳc cú triu chng u tiờn n vo vin: thỏng Cỏc tchng khỏm: cú Y khụng N hch ngoi vi Nhim trựng 15 u cnh ct sng u hc mt xut huyt 16 u hch bng u vũng Waldeyer 10 u xng 17 u bung trng u xoang s 11 u trung tht 18 tr dch/mỏu MP gan to 12 U vựng rng hm 19 tr dch/mỏuMB lỏch to 13 u h tit niu 20 u vựng -M-c U hc mi 14 u tinh hon 21.ThnhimTKTW Cỏc v trớ hch: cú Y, khụng N hch u mt c hch nỏch hch trung tht hch bng hch bn Chn oỏn giai on: theo St Jude Footer Page 159 of 161 Header Page 160 of 161 Giai Mụ t on I Mt u (ngoi hch) hay mt vựng gii phu (hch) ngoi tr trung tht hay bng II Mt u (ngoi hch) kốm xõm ln hch vựng Hai hay nhiu hch vựng cựng mt phớa c honh Hai hay nhiu u (ngoi hch) kốm hay khụng xõm ln hch vựng cựng mt phớa c honh Mt u nguyờn phỏt ng tiờu hoỏ thng l vựng hi trng kốm hay khụng xõm ln hch mc treo III Hai u (ngoi hch) hai phớa ca c honh Hai hay nhiu vựng hch hai phớa ca c honh Tt c cỏc u lng ngc (trung tht, mng phi, tuyn c) Tt c nhng u nguyờn phỏt bng Tt c cỏc u cnh ct sng hay ngoi mng cng bt k cỏc v trớ u khỏc IV Bt k v trớ no nh trờn kốm xõm ln h thn kinh trung ng v/hoc tu xng Triu chng ton thõn: Hi chng B Y cú, N khụng Thiu mỏu Gy sỳt III Xột nghim: Mụ bnh hc nhum HE: Nhum HMMD phõn loi theo WHO 2001: Dng tớnh vi: m tớnh vi: Kt lun: Footer Page 160 of 161 Header Page 161 of 161 Sinh hoỏ trc iu tr: 1.bỡnh thng, 2.tng va, 3.tng cao, 4.khụng lm LDH SGOT Ure 2-microglobulin SGPT Creatinin Acid uric Tu trc iu tr: bỡnh thng, thõm nhim tu, T l t bo non tu %, ngoi vi % X quang tim phi: 1.Bỡnh thng, 2.Cú u hch trung tht Tn thng nhu mụ phi, Trn dch mng phi Siờu õm bng: 1.Bỡnh thng, 2.Gan lỏch to 3.U, hch bng, Trn dch mng bng Footer Page 161 of 161 Header Page 162 of 161 TH GI BNH NHN Kớnh gi: ễng (b): L cha (m, ụng b, ngi thõn) ca chỏu: L bnh nhõn ca khoa nhi, bnh vin K, s h s: Nhm phc v cụng tỏc nghiờn cu, ghi nhn v rỳt kinh nghim chn oỏn, iu tr bnh ung th núi chung, bnh u lympho ỏc tớnh khụng Hodgkin núi riờng, xin ụng (b) vui lũng tr li mt s cõu hi sau õy: Hin chỏu cũn sng hay ó mt: Cũn sng ó mt Nu cũn sng, xin ụng b vui lũng cho bit tỡnh hỡnh c th: Khe mnh Tỏi phỏt Nu chỏu tỏi phỏt bnh, xin ụng (b) vui lũng cho bit chỏu c xỏc nh tỏi phỏt t ngy.thỏng.nm Nu chỏu ó mt, xin c chia bun sõu sc cựng gia ỡnh Xin ụng (b) vui lũng cho bit chỏu mt ngy.thỏngnm.(dng lch ? m lch ?) Nu chỏu ó mt, xin vui lũng cho bit nguyờn nhõn mt m bỏc s thụng bỏo? Nhim trựng Bnh tỏi phỏt tin trin Xut huyt Suy ty Khụng liờn quan bnh v iu tr Suy hụ hp Xin trõn trng cm n ụng (b) ó dnh thi gian tr li Chỳc ụng b v gia ỡnh mnh khe Kớnh th Bs Phm Th Vit Hng Footer Page 162 of 161 Header Page 163 of 161 DANH SCH BNH NHN THAM GIA NGHIấN CU Tờn lun ỏn: Nghiờn cu c im lõm sng, mụ bnh hc u lympho ỏc tớnh khụng Hodgkin tr em v kt qu iu tr giai on III+IV bng phỏc NHL BFM 90 ti bnh vin K STT H v tờn Tui Gii S h s Nguyn Vn H 16 Nam 2559/06 Nguyn ỡnh Tr 12 Nam 5083/08 Trn Quc T Nam 1660/07 T Vn Th 12 Nam 3733/09 Nguyn Gia X 11 Nam 4410/06 Qung Vn H Nam 3410/07 Nguyn Tun A Nam 4409/07 Mai Vn G 12 Nam 995/05 Nguyn Tin D 14 Nam 460/05 10 Tng Xuõn H Nam 4953/10 11 Nguyn Vn T 15 Nam 4120/05 12 Phm Gia Nam 155/05 13 Nguyn Duy B Nam 420/05 14 Nguyn Ngc Q Nam 4250/05 15 Nguyn Vn L Nam 772/06 16 Hong c H Nam 291/06 17 Hong Phng N Nam 2160/06 18 Lờ Vn C Nam 234/05 19 V Vn T 14 Nam 987/06 20 V Thanh T Nam 5199/07 21 Ng Th Kim B 12 N 286/08 22 Ng Lu Bch D 15 N 5880/06 Footer Page 163 of 161 Header Page 164 of 161 23 Phm Xuõn H Nam 1773/06 24 Trng Cụng H 10 Nam 945/06 25 H Quang C Nam 536/11 26 Hong Th L 15 N 1410/06 27 Nguyn Vn C 12 Nam 234/05 28 o Th V N 2593/07 29 Nguyn Vn Q 15 Nam 7700/06 30 Bựi Vn C Nam 4842/06 31 Nguyn Vn 11 Nam 2702/06 32 Trng Cụng H 11 Nam 945/06 33 Trn Th D Nam 2913/11 34 Trn Tun A Nam 3202/08 35 Lũ Th Hng T 15 N 2995/06 36 Bựi Vit 3,5 Nam 4732/06 37 Lũ Vn T 12 Nam 1563/07 38 Nguyn Danh S 13 Nam 3712/05 39 Lng Vn Nam 4851/06 40 V ỡnh L 11 Nam 1886/06 41 Ng Bng Nam 2579/08 42 Nụng Tun V 14 Nam 1804/10 43 Nguyn Vn V 14 Nam 247/07 44 Dng T N X 3,5 N 1174/08 45 Tụ Hng N N 511/08 46 Nguyn Huy H 12 Nam 3357/05 47 Chu Xuõn H 3,5 Nam 3396/06 48 Lờ Quc T 14 Nam 3797/05 49 Nguyn Hu T 10 Nam 1314/06 50 Hong Quc V Nam 4978/11 51 Trn ỡnh L 15 Nam 664/05 Footer Page 164 of 161 Header Page 165 of 161 52 o Th X 15 N 3097/08 53 Bựi Xuõn M Nam 3046/06 54 Nguyn Vn T 14 Nam 4120/05 55 Trn Vn C Nam 4224/05 56 Nụng Vn C Nam 71/06 57 ỡnh T Nam 755/06 58 Lờ nh H 13 N 8811/07 59 V Vn T Nam 987/06 60 Nguyn Vn H Nam 2539/06 61 Hong Ngc H Nam 3660/06 62 Hong Vn G 16 Nam 232/07 63 Hong Ngc D 12 Nam 1725/05 64 Mai Vn G 12 Nam 995/05 65 Nguyn Vn C Nam 546/06 66 Nguyn Thanh S Nam 4117/11 67 Nguyn Tun A Nam 4409/07 68 Nguyn Th H 16 N 4097/06 69 Lờ Th Tr 12 N 8429/08 70 Phan Vn Th 14 Nam 5109/09 71 Phm Anh P Nam 1684/12 72 Trng Nguyn ng P Nam 2060/09 73 H Minh H N 2872/10 H ni ngy 20 thỏng nm 2016 Xỏc nhn ca thy hng dn Xỏc nhn ca phũng KHTH bnh vin K Footer Page 165 of 161 ... NGHIÊN C U K T QUả ĐI U TRị U LYMPHO áC TíNH KHÔNG HODGKIN TRẻ EM GIAI ĐOạN III+IV BằNG PHáC Đồ NHL - BFM 90 TạI BệNH VIệN K Chuyờn ngnh : Ung th Mó s : 62720149 LUN N TIN S Y HC Ngi hng dn khoa... + U lympho t bo B ln trung tht + U lympho t bo B ln mch + U lympho trn dch tiờn phỏt + U lympho/ bnh bch cu Burkitt Cỏc u t bo T v NK - Cỏc u t bo T tin thõn + Bnh bch cu /u lympho nguyờn bo lympho. .. ti u nghiờn cu: Mụ t mt s c im lõm sng, mụ bnh hc ULAKH tr em giai on III+IV iu tr ti bnh vin K t 1/6/2005 n 30/10/2014 ỏnh giỏ kt qu iu tr ULAKH giai on III+IV ca s tr em ny bng phỏc NHL - BFM