Willemze R, Hillen H, Hartgrink-Groeneveld C A, Haanen C
Blood. 1975 Dec;46(6):823-34.
During the period from January 1970 until December 1973, therapy was started in 41 previously untreated adolescents and adults with acute lymphoblastic leukemia. Induction therapy was started with vincristine and prednisone in all patients, resulting in complete remission in 19 and death due to infection during the first month in one case. After 3 wk on these two drugs, the addition of daunorubicin was required in the remaining 21 patients. Fifteen of these obtained remission, one died during induction therapy, and five patients were unresponsive to this therapy, as well as to all subsequent induction schemes. The overall remission rate was 83%. Significantly higher initial leukocyte counts were found in the group treated with vincristine, prednisone, and daunorubicin. Meningeal leukemia prophylaxis, by either periodic methotrexate injections given intrathecally or a combination of cranial irradiation and intrathecally administrated methotrexate, was administered in 29 therapy responders. The median duration of complete remission obtained with various maintenance therapy schemes was 13 mo. No differences were seen in the results obtained in patients between 14 and 20 yr of age and older patients. Twenty-two patients relapsed within 2-37 mo. Relapses were confined to the central nervous system in two cases, to the bone marrow in 18, and to the bone marrow and CNS simultaneously in two. A second remission was obtained in 17 cases (77%). The median survival time of the whole group was 27 mo, as compared with 32 mo for therapy responders and 7 mo for the nonresponders. The percentage and duration of remission and the survival time in our group of adolescents and adults were comparable to those currently being achieved in other centers, but not as good as those reported for children treated with the same protocols.
在1970年1月至1973年12月期间，对41例既往未接受治疗的青少年和成人急性淋巴细胞白血病患者开始进行治疗。所有患者均以长春新碱和泼尼松开始诱导治疗，19例获得完全缓解，1例在第一个月因感染死亡。使用这两种药物3周后，其余21例患者需要加用柔红霉素。其中15例获得缓解，1例在诱导治疗期间死亡，5例对该治疗以及所有后续诱导方案均无反应。总体缓解率为83%。在用长春新碱、泼尼松和柔红霉素治疗的组中发现初始白细胞计数明显更高。对29例治疗有反应者进行了脑膜白血病预防，方法是定期鞘内注射甲氨蝶呤或联合颅脑照射和鞘内注射甲氨蝶呤。各种维持治疗方案获得的完全缓解的中位持续时间为13个月。14至20岁患者与年龄较大患者的治疗结果未见差异。22例患者在2至37个月内复发。2例复发局限于中枢神经系统，18例复发于骨髓，2例同时复发于骨髓和中枢神经系统。17例（77%）获得第二次缓解。整个组的中位生存时间为27个月，治疗有反应者为32个月，无反应者为7个月。我们组青少年和成人的缓解百分比、缓解持续时间和生存时间与其他中心目前所取得的结果相当，但不如采用相同方案治疗的儿童所报告的结果好。
