Gerrard Mary, Cairo Mitchell S, Weston Claire, Auperin Anne, Pinkerton Ross, Lambilliote Anne, Sposto Richard, McCarthy Keith, Lacombe Marie-José T, Perkins Sherrie L, Patte Catherine
Sheffield Children's Hospital, Sheffield, UK.
Br J Haematol. 2008 Jun;141(6):840-7. doi: 10.1111/j.1365-2141.2008.07144.x. Epub 2008 Mar 26.
High cure rates are possible in children with localized mature B-cell lymphoma (B NHL) using a variety of chemotherapeutic strategies. To reduce late sequelae, the duration and intensity of chemotherapy has been progressively reduced. The Lymphome Malins de Burkitt (LMB) 89 study reported long-term survival in almost all children with localized resected disease treated with two courses of COPAD (cyclophosphamide, vincristine, prednisolone and doxorubicin). This study was designed to confirm the effectiveness of this approach in a larger number of patients in a multinational co-operative study. The patient cohort was part of an international study (French-American-British LMB 96), which included all disease stages and involved three national groups. Patients in this part of the study had resected stage I or completely resected abdominal stage II disease. Following surgery, two courses of COPAD were given, without intrathecal (IT) chemotherapy. One hundred and thirty-two children were evaluable. Two of 264 (0.9%) courses were associated with grade IV toxicity (one stomatitis and one infection). With a median follow up of 50.5 months, the 4 year event-free survival is 98.3% and overall survival is 99.2%. Children with resected localized B-NHL can be cured with minimal toxicity following two courses of low intensity treatment without IT chemotherapy.
采用多种化疗策略治疗局限性成熟B细胞淋巴瘤(B-NHL)患儿有望获得高治愈率。为减少远期后遗症,化疗的疗程和强度已逐步降低。淋巴瘤-伯基特氏病(LMB)89研究报告称,几乎所有接受两个疗程COPAD(环磷酰胺、长春新碱、泼尼松龙和阿霉素)治疗且局限性病灶已切除的患儿均实现了长期生存。本研究旨在通过一项多国合作研究,在更多患者中证实该方法的有效性。患者队列是一项国际研究(法美英LMB 96)的一部分,该研究涵盖了所有疾病阶段,涉及三个国家的研究团队。本研究部分的患者已切除I期病灶或已完全切除腹部II期病灶。手术后,给予两个疗程的COPAD治疗,不进行鞘内(IT)化疗。132名儿童可进行评估。264个疗程中有2个(0.9%)出现IV级毒性反应(1例口腔炎和1例感染)。中位随访50.5个月,4年无事件生存率为98.3%,总生存率为99.2%。接受手术切除的局限性B-NHL患儿在接受两个疗程的低强度治疗且不进行IT化疗后,可在毒性最小的情况下治愈。