Balwierz Walentyna, Moryl-Bujakowska Angelina, Skoczeń Szymon, Pawińska Katarzyna, Balcerska Anna, Płoszyńska Anna, Chybicka Alicja, Dobaczewski Grzegorz, Juszczak Katarzyna, Wachowiak Jacek, Derwich Katarzyna, Kowalczyk Jerzy, Wiśniewska-Slusarz Hanna, Matysiak Michał, Krauze Agnieszka, Rokicka-Milewska Roma, Pawelec Katarzyna, Sońta-Jakimczyk Danuta, Łuszczyńska Aleksandra, Tomaszewska Renata, Wysocki Mariusz, Styczyński Jan, Swiatkiewicz Violetta
Klinika Onkologii i Hematologii Dzieciecej P-A Instytutu Pediatrii Wydziału Lekarskiego Uniwersytetu Jagiellońskiego w Krakowie. 30-663 Kraków, ul, Wielicka 265.
Przegl Lek. 2003;60 Suppl 5:13-6.
From 1981 to 1986, in children with ALL and initial WBC > or = 50,000/mm3, over 6-year disease-free survival was significantly lower (33%) than in children with WBC < 50,000/mm3 (60%). In attempt to improve this unsatisfactory results, three modified American protocols named: "New York", "New York I", and "New York II", "New York I", and "New York II" were introduced consecutively in the centers of Polish Pediatric Leukemia Lymphoma Study Group (respectively, in 1987, 1997, and 1999). The treatment results achieved in three consecutive therapeutic groups of children with ALL and initial WBC > or = 50,000/mm3: group I--213 children (1987-1996), group II--58 children (1997-1999), and group III--52 children (1999-2001) are presented. The observation was completed in December 31, 2002. In three evaluated groups the first complete remissions (CRs) were achieved in 90.6%. 94.8%. and 94.2% of patients, respectively. Relapses occurred in 71 patients of group I (37%), in 9 patients of group II (16%), and in 6 patients of group III (12%). The complications of treatment caused death in 7 children of group I, in 1 child of group II, and in 2 children of group III. Eighty-one (38%), 11 (18.9%), and 9 (17.3%) patients, respectively, died due to progression of disease. The event-free survival (EFS) in three evaluated groups did not depend on age of children and WBC. The rates of 2-, 5-, and 10-year event-free survival (EFS) in group I were: 69.9%, 55.3%, and 53.6%, respectively and the rates of 2- and 5-year EFS in group II were: 80.7% and 72.7%, respectively. The rate of 2-year EFS in group III was 71.6%. The analysis of achieved treatment results in three evaluated groups shows the gradual improvement of the prognosis in children with ALL and initial WBC > or = 50,000/mm3 treated with the use of modified protocols "New York" and "New York I" in comparison with patients treated before 1987. Longer observation is needed for evaluation of efficacy and complications of "New York II" protocol.
1981年至1986年期间，在初始白细胞计数（WBC）≥50,000/mm³的急性淋巴细胞白血病（ALL）患儿中，6年以上无病生存率（33%）显著低于WBC＜50,000/mm³的患儿（60%）。为改善这一不尽人意的结果，波兰儿童白血病淋巴瘤研究组的各中心相继引入了三种改良的美国方案，即“纽约”、“纽约I”和“纽约II”方案（分别于1987年、1997年和1999年引入）。本文呈现了ALL且初始WBC≥50,000/mm³的三组连续治疗患儿的治疗结果：第一组——213名患儿（1987 - 1996年），第二组——58名患儿（1997 - 1999年），第三组——52名患儿（1999 - 2001年）。观察于2002年12月31日结束。在三个评估组中，分别有�0.6%、94.8%和94.2%的患者实现了首次完全缓解（CR）。第一组71名患者（37%）、第二组9名患者（16%）和第三组6名患者（12%）出现复发。治疗并发症导致第一组7名患儿、第二组1名患儿和第三组2名患儿死亡。分别有81名（38%）、11名（18.9%）和9名（17.3%）患者因疾病进展死亡。三个评估组的无事件生存率（EFS）与患儿年龄和WBC无关。第一组2年、5年和10年的无事件生存率分别为69.9%、55.3%和53.6%，第二组2年和5年的EFS分别为80.7%和72.7%。第三组2年的EFS为71.6%。对三个评估组所取得治疗结果的分析表明，与1987年之前接受治疗的患者相比，采用改良方案“纽约”和“纽约I”治疗的ALL且初始WBC≥50,000/mm³患儿的预后逐渐改善。需要更长时间的观察来评估“纽约II”方案的疗效和并发症。
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