Sánchez Fayos J, Bernacer M, Olavarría E, Outeiriño J, Prieto E, Román A, Pacho E, Villalobos E, Pérez A, Myric A
Servicio de Hematología, Fundación Jiménez Díaz, Facultad de Medicina, Universidad Autónoma, Madrid.
Sangre (Barc). 1992 Dec;37(6):439-47.
To retrospectively analyse all the patients diagnosed and treated in the same hospital for acute lymphoblastic leukaemia (ALL) in whom therapy was suppressed after sustained complete remission (CR) for a variable period.
Eighty cases of ALL treated at the Jiménez Díaz Foundation between 1968 and 1991 were revised. Treatment had been suppressed after 60 months of maintained CR (1968-1974) or after 28 months (1986-1991), with a median follow-up after suppression of 6 years. All the patients had been treated with several protocols (FJD-68, FJD/BFM, APO, BFM-83, BFM-86 and BFM-90). Maintained CR, relapses and course after therapy cessation were analysed. Actuarial curves of RC duration and survival were drawn according to the Cutler and Ederer life tables.
The age at diagnosis ranged from 1.5 to 68 years. Childhood (< 15 years) ALL presented in 49 cases; 25 were young adults (15-30 years), and 6 others were over 30 years of age. Two of the 80 patients (2.5%) died in CR (astrocytoma and demyelinating leukoencephalopathy). Fifty-eight patients (72.5%) are living in maintained CR; 20 others relapsed (25%), 14 of them (70%) attaining a second CR. Allogenic BMT was carried out in 4 such cases. Four patients are out of any treatment after the second CR. The actuarial curves of CR duration after suppression of therapy gave a stable plateau at 73% for children, at 75% for young adults and at 22% for patients over 30 years. The survival after suppression of therapy showed a plateau at 75% for children and at 86% for young adults.
回顾性分析在同一家医院诊断和治疗的所有急性淋巴细胞白血病（ALL）患者，这些患者在持续完全缓解（CR）一段可变时间后治疗被中止。
对1968年至1991年间在希门尼斯·迪亚斯基金会接受治疗的80例ALL患者进行了回顾。治疗在维持CR 60个月后（1968 - 1974年）或28个月后（1986 - 1991年）被中止，中止治疗后的中位随访时间为6年。所有患者均接受了多种方案治疗（FJD - 68、FJD/BFM、APO、BFM - 83、BFM - 86和BFM - 90）。分析了维持CR情况、复发情况以及治疗停止后的病程。根据卡特勒和埃德勒生命表绘制了缓解持续时间和生存的精算曲线。
诊断时年龄范围为1.5岁至68岁。儿童期（<15岁）ALL患者49例；25例为青年成人（15 - 30岁），另外6例年龄超过30岁。80例患者中有2例（2.5%）在CR期死亡（星形细胞瘤和脱髓鞘性白质脑病）。58例患者（72.5%）处于维持CR状态；另外20例复发（25%），其中14例（70%）再次获得CR。4例此类患者接受了异基因骨髓移植。4例患者在第二次CR后停止了任何治疗。治疗中止后缓解持续时间的精算曲线显示，儿童患者为73%，青年成人患者为75%，30岁以上患者为22%，呈稳定平台期。治疗中止后的生存率显示，儿童患者为75%，青年成人患者为86%，呈平台期。
1）治疗停止后25%的患者出现复发。2）75%的复发发生在治疗停止后的头两年。3）撰写本文时，78.7%的患者维持CR状态。4）30岁以上的成人预后最差。5）本系列中青年成人患者治疗停止后的病程与儿童患者一样好。
