复发型脑膜白血病和淋巴瘤患者的脑室内甲氨蝶呤和阿糖胞苷浓度-时间乘积（C×T）
Intraventricular concentration times time (C x T) methotrexate and cytarabine for patients with recurrent meningeal leukemia and lymphoma.
作者信息
Moser A M, Adamson P C, Gillespie A J, Poplack D G, Balis F M
机构信息
Pediatric Oncology Branch, National Cancer Institute, Bethesda, Maryland 20892, USA.
出版信息
Cancer. 1999 Jan 15;85(2):511-6. doi: 10.1002/(sici)1097-0142(19990115)85:2<511::aid-cncr33>3.0.co;2-h.
BACKGROUND
Intraventricular chemotherapy results in more uniform drug distribution within the subarachnoid space and allows for more flexible drug administration schedules. The authors report their experience with an intraventricular concentration times time (C x T) chemotherapy regimen for recurrent meningeal leukemia and lymphoma.
METHODS
Twenty-one patients (median age, 11.6 years) received C x T therapy for meningeal acute lymphoblastic leukemia (n = 18), Burkitt's lymphoma (n = 2), or undifferentiated leukemia (n = 1). Prior therapy included standard intrathecal (IT) methotrexate and cytarabine, cranial or craniospinal radiation (median, 24 Gy), and 0-5 experimental treatment modalities. C x T induction therapy consisted of 2 mg of intraventricular methotrexate administered daily for 3 days every 10 days, for 4 courses. Patients were then consolidated with 4 courses of alternating intraventricular cytarabine (15 mg/day) or methotrexate (2 mg/day) daily for 3 days every 2 weeks (2 courses of methotrexate and 2 courses of cytarabine). Maintenance therapy consisted of alternating monthly courses of C x T methotrexate or cytarabine.
RESULTS
Ninety-three percent of patients (14 of 15) who were evaluable for response achieved a complete remission in a median of 10 days (range, 2-40 days). Median remission duration was 15 months. Fourteen patients died of recurrent disease or systemic treatment-related complications; 2 patients are alive, off treatment, and in continuous complete remission for 59+ and 89+ months; 1 patient experienced a meningeal relapse at 24 months on C x T therapy but was reinduced with the C x T regimen, received craniospinal radiation, and is in remission at 142+ months; and 3 are alive with disease at 32+, 72+, and 81+ months. One patient was lost to follow-up.
CONCLUSIONS
This regimen appears to be an effective and well-tolerated palliative treatment for patients with recurrent meningeal leukemia and lymphoma.
背景
脑室内化疗可使药物在蛛网膜下腔内分布更均匀，并允许采用更灵活的给药方案。作者报告了他们使用脑室内浓度乘以时间（C×T）化疗方案治疗复发性脑膜白血病和淋巴瘤的经验。
方法
21例患者（中位年龄11.6岁）接受C×T治疗，其中脑膜急性淋巴细胞白血病18例、伯基特淋巴瘤2例、未分化白血病1例。先前的治疗包括标准鞘内注射甲氨蝶呤和阿糖胞苷、颅脑或全脊髓放疗（中位剂量24 Gy）以及0至5种实验性治疗方式。C×T诱导治疗包括每10天每天脑室内注射2 mg甲氨蝶呤，共3天，进行4个疗程。然后患者接受4个疗程的巩固治疗，交替使用脑室内阿糖胞苷（15 mg/天）或甲氨蝶呤（2 mg/天），每2周每天3天（2个疗程甲氨蝶呤和2个疗程阿糖胞苷）。维持治疗包括每月交替进行C×T甲氨蝶呤或阿糖胞苷疗程。
结果
可评估反应的患者中有93%（15例中的14例）在中位时间10天（范围2 - 40天）内实现完全缓解。中位缓解持续时间为15个月。14例患者死于疾病复发或全身治疗相关并发症；2例患者存活，停止治疗，持续完全缓解59多个月和89多个月；1例患者在接受C×T治疗24个月时出现脑膜复发，但通过C×T方案再次诱导缓解，接受了全脊髓放疗，目前在142多个月时仍处于缓解状态；3例患者在32多个月、72多个月和81多个月时带瘤存活。1例患者失访。
结论
该方案似乎是复发性脑膜白血病和淋巴瘤患者一种有效且耐受性良好的姑息治疗方法。
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