Lobato-Mendizábal E, Ruiz-Argüelles G J
Hospital Universitario de Puebla, México.
Rev Invest Clin. 1990 Apr-Jun;42(2):81-7.
In previous papers we have shown that malnutrition is an adverse prognostic factor in the outcome of treatment in patients with standard-risk acute lymphoblastic leukemia. The reason why undernourished children do poorly as compared with well nourished children is that malnourishment leads to a diminished bone marrow reserve thus making necessary to delivery of suboptimal doses of maintenance chemotherapy (less than that calculated according to body surface). Undernourished children receive less 6-MP and MTX and relapse more frequently in the bone marrow, finally reflecting a 5 yr disease-free survival of 26% as compared with 83% in well-nourished children (p less than 0.001). In this paper we have analyzed the impact of the variable delivery of sub-optimal doses of maintenance chemotherapy in a group of 43 pediatric patient with standard-risk acute lymphoblastic leukemia. The 5 year disease free survival of children receiving suboptimal maintenance chemotherapy was 7% as compared with 65% for those receiving full doses of both 6-MP and MTX (p less than 0.001), and more frequent relapse involving the bone marrow in children receiving low doses (71% versus 3%, p = 0.000005). The impact of the variable suboptimal doses of chemotherapy was present in children with both normal and deficient nourishment status. It is concluded that the delivery of suboptimal doses of maintenance chemotherapy, due to bone marrow toxicity related to an abnormal myelopoietic reserve, is an adverse prognostic factor in the outcome to treatment of patients with lymphoblastic leukemia.
在之前的论文中，我们已经表明，营养不良是标准风险急性淋巴细胞白血病患者治疗结果中的一个不良预后因素。与营养良好的儿童相比，营养不良的儿童预后较差的原因在于，营养不良会导致骨髓储备减少，从而使得维持化疗只能给予次优剂量（低于根据体表面积计算的剂量）成为必要。营养不良的儿童接受的6-巯基嘌呤（6-MP）和甲氨蝶呤（MTX）较少，骨髓复发更为频繁，最终导致5年无病生存率为26%，而营养良好的儿童为83%（p<0.001）。在本文中，我们分析了次优剂量维持化疗的不同给药方式对一组43例标准风险急性淋巴细胞白血病儿科患者的影响。接受次优维持化疗的儿童5年无病生存率为7%，而接受全剂量6-MP和MTX的儿童为65%（p<0.001），并且接受低剂量化疗的儿童骨髓复发更为频繁（71%对3%，p=0.000005）。化疗剂量次优变化的影响在营养状况正常和营养不足的儿童中均存在。结论是，由于与异常骨髓造血储备相关的骨髓毒性，给予次优剂量的维持化疗是淋巴细胞白血病患者治疗结果的一个不良预后因素。
