Malhotra Pankaj, Varma Subhash, Varma Neelam, Kumari Savita, Das Reena, Jain Sanjay, Ahluwalia Jasmina, Mahi Sushil, Sharma Suresh Chander, Radhika Srinivasan
Department of Internal Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
Leuk Lymphoma. 2007 Jun;48(6):1173-8. doi: 10.1080/10428190701343255.
Cure rates for adult acute lymphoblastic leukemia (ALL) in developing countries are significantly lower because of problems unique to these countries. We assessed some of the problems in adult ALL patients (>12 years of age) in a tertiary care hospital of northwest India with modified BFM regimen. The diagnosis of ALL was made according to FAB criteria. The protocol consisted of Phase I & II induction, consolidation, reinduction and maintenance phases. CNS prophylaxis was administered with 24 Gy radiation and intrathecal methotrexate. One hundred and eighteen patients (72.9% males), aged 12-68 years (median 23 years) were treated from January 1997 till December 2003. Follow-up of patients was done till December 2005. Complete remission (CR) was achieved in 85.6% patients after induction therapy and 40% patient relapsed. Most patients (23.7%) relapsed during the maintenance phase or after completion of chemotherapy. At least 15% of patients (15/101) after successful induction abandoned the treatment because of financial constraints, prolonged travel time to treatment facility and switching over to alternative medicines. Fatal infectious complications occurred in 19.5% of patients. The 3-year and 5-year event free survival rates were 29.8% and 21.6% respectively. In conclusion, modified BFM regimen resulted in high induction rates but relatively poor 5-year event free survival. Infections related death and post induction abandonment of treatment were the main reasons for poor overall results.
由于一些特定问题，发展中国家成人急性淋巴细胞白血病（ALL）的治愈率显著较低。我们在印度西北部一家三级护理医院采用改良BFM方案评估了成人ALL患者（年龄>12岁）面临的一些问题。ALL的诊断依据FAB标准。该方案包括I期和II期诱导、巩固、再诱导及维持阶段。采用24 Gy放疗和鞘内注射甲氨蝶呤进行中枢神经系统预防。1997年1月至2003年12月期间共治疗了118例患者（男性占72.9%），年龄在12 - 68岁（中位年龄23岁）。对患者的随访持续至2005年12月。诱导治疗后85.6%的患者达到完全缓解（CR），40%的患者复发。大多数患者（23.7%）在维持阶段或化疗结束后复发。成功诱导后至少15%的患者（15/101）因经济限制、前往治疗机构路途时间过长以及改用替代药物而放弃治疗。19.5%的患者发生致命感染并发症。3年和5年无事件生存率分别为29.8%和21.6%。总之，改良BFM方案诱导率高，但5年无事件生存率相对较差。感染相关死亡和诱导后放弃治疗是总体结果不佳的主要原因。
