鞘内注射甲氨蝶呤联合或不联合颅脑放疗在预防急性淋巴细胞白血病中枢神经系统复发中的疗效

Efficacy of intrathecal methotrexate with and without cranial radiotherapy in preventing central nervous system relapses in acute lymphocytic leukemia.

作者信息

Choudhry V P, Krishnamurthy L, Rath G K, Arya L S, Pati H, Saraya A K

机构信息

Department of Hematology, Pediatrics and Radiotherapy (IRCH), All India Institute of Medical Sciences, New Delhi.

出版信息

Indian Pediatr. 1992 Jul;29(7):843-9.

PMID:1428132

Abstract

Introduction of CNS chemoprophylaxis was a major milestone in the development of current therapy for acute lymphocytic leukemia. However, controversies are still existing for ideal form of CNS chemoprophylaxis. The present study was conducted to determine the efficacy of intrathecal methotrexate (IT-MTX) with and without cranial radiotherapy in preventing CNS relapses in Indian children. CNS chemoprophylaxis comprising of six injections of intrathecal methotrexate (12 mg/M2) was administered alone or along with cranial radiotherapy (2000 GY) in 76 children each after successful induction remission. Cranial radiotherapy (RT) with intrathecal methotrexate (IT-MTX) was observed to be more effective as CNS relapses were seen in 11.8% of children as compared to 16.8% of children receiving IT-MTX alone. IT-MTX along with cranial RT delayed the occurrence of CNS relapses and prolonged the event free survival periods.

摘要

中枢神经系统化学预防的引入是当前急性淋巴细胞白血病治疗发展中的一个重要里程碑。然而，关于中枢神经系统化学预防的理想形式仍存在争议。本研究旨在确定鞘内注射甲氨蝶呤（IT-MTX）联合或不联合颅脑放疗在预防印度儿童中枢神经系统复发方面的疗效。在76名儿童成功诱导缓解后，单独给予由六次鞘内注射甲氨蝶呤（12 mg/M²）组成的中枢神经系统化学预防，或联合颅脑放疗（2000戈瑞）。观察到鞘内注射甲氨蝶呤联合颅脑放疗更有效，接受联合治疗的儿童中枢神经系统复发率为11.8%，而单独接受鞘内注射甲氨蝶呤的儿童复发率为16.8%。鞘内注射甲氨蝶呤联合颅脑放疗延迟了中枢神经系统复发的发生，并延长了无事件生存期。