西班牙急性白血病中枢神经系统预防与治疗实践。前瞻性注册研究。

Practice of central nervous system prophylaxis and treatment in acute leukemias in Spain. Prospective registry study.

作者信息

Sancho Juan-Manuel, Morgades Mireia, Arranz Reyes, Fernández-Abellán Pascual, Deben Guillermo, Alonso Natalia, Blanes Margarita, Rodríguez María José, Nicolás Concepción, Sánchez Eva, Fernández de Sevilla Alberto, Conde Eulogio, Ribera Josep-Maria

机构信息

Servicio de Hematología Clínica, ICO-Hospital Germans Trias i Pujol, Badalona, Barcelona, España.

出版信息

Med Clin (Barc). 2008 Oct 4;131(11):401-5. doi: 10.1157/13126214.

DOI:10.1157/13126214

PMID:18928719

Abstract

BACKGROUND AND OBJECTIVE

Central nervous system (CNS) involvement in patients diagnosed with acute leukemias (AL) is an uncommon complication with poor prognosis. The indication and the schedules of prophylaxis and treatment of CNS involvement in AL are not homogenous among countries and within the same country. The aim of this prospective longitudinal study was to analyze and report the practice of CNS prophylaxis and treatment in patients with AL in Spain.

PATIENTS AND METHOD

Prospective study conducted from June 2005 to June 2006. Adult patients (> or = 18 yr.) diagnosed with AL who received CNS prophylaxis or treatment were consecutively included through online registration.

RESULTS

265 patients from 32 hospitals were included. Mean (standard deviation) age was 44 (16) yr. and 133 (50%) were males. For acute lymphoblastic leukemia patients (n = 158), CNS therapy was given to 12 cases (10 at diagnosis and 2 at relapse) and consisted of triple intrathecal therapy (TIT, methotrexate, cytarabine and hydrocortisone) in 11 and liposomal depot cytarabine in one. CNS prophylaxis (n = 146) consisted of TIT in 135 cases, intrathecal methotrexate in 7, intrathecal cytarabine in 2 and intrathecal liposomal depot cytarabine in 2. No cranial irradiation either for prophylaxis or therapy was given in any case. In acute myeloblastic leukemia patients (n = 107), CNS therapy was administered to 17 cases (9 at diagnosis and 8 at relapse). Intrathecal therapy consisted of TIT in 11, intrathecal liposomal depot cytarabine in 5 and intrathecal cytarabine in one. One patient also received craniospinal irradiation. CNS prophylaxis (n = 90) consisted of TIT in 68 cases and intrathecal methotrexate in 22.

CONCLUSIONS

In Spain, the patterns of CNS prophylaxis and therapy for AL are homogeneous. TIT was the most frequent schedule for CNS prophylaxis and therapy. The lack of use of cranial or craniospinal irradiation and the administration of new drugs (i.e.: liposomal depot cytarabine) for CNS therapy and prophylaxis is of note.

摘要

背景与目的

中枢神经系统（CNS）受累于诊断为急性白血病（AL）的患者是一种预后不良的罕见并发症。各国以及同一国家内，AL中枢神经系统受累的预防和治疗指征及方案并不统一。这项前瞻性纵向研究的目的是分析并报告西班牙AL患者中枢神经系统预防和治疗的实践情况。

患者与方法

2005年6月至2006年6月进行的前瞻性研究。通过在线注册连续纳入诊断为AL且接受中枢神经系统预防或治疗的成年患者（≥18岁）。

结果

纳入了来自32家医院的265例患者。平均（标准差）年龄为44（16）岁，男性133例（50%）。对于急性淋巴细胞白血病患者（n = 158），12例接受了中枢神经系统治疗（诊断时10例，复发时2例），其中11例采用三联鞘内注射治疗（TIT，甲氨蝶呤、阿糖胞苷和氢化可的松），1例采用脂质体阿糖胞苷。中枢神经系统预防（n = 146）中，135例采用TIT，7例采用鞘内注射甲氨蝶呤，2例采用鞘内注射阿糖胞苷，2例采用鞘内注射脂质体阿糖胞苷。无论预防还是治疗，均未进行颅脑照射。对于急性髓细胞白血病患者（n = 107），17例接受了中枢神经系统治疗（诊断时9例，复发时8例）。鞘内治疗包括11例TIT，5例鞘内注射脂质体阿糖胞苷，1例鞘内注射阿糖胞苷。1例患者还接受了全脑全脊髓照射。中枢神经系统预防（n = 90）中，68例采用TIT，22例采用鞘内注射甲氨蝶呤。