系统评价和随机临床试验的荟萃分析，旨在探讨中枢神经系统定向治疗对儿童急性淋巴细胞白血病的作用。
Systematic review and meta-analysis of randomized trials of central nervous system directed therapy for childhood acute lymphoblastic leukemia.
机构信息
University of Oxford, Oxford, UK.
出版信息
Pediatr Blood Cancer. 2013 Feb;60(2):185-95. doi: 10.1002/pbc.24228. Epub 2012 Jun 12.
Abstract
Treatment of the central nervous system (CNS) is an essential therapy component for childhood acute lymphoblastic leukemia (ALL). Individual patient data from 47 trials addressing 16 CNS treatment comparisons were analyzed. Event-free survival (EFS) was similar for radiotherapy versus intrathecal (IT), and radiotherapy plus IT versus IV methotrexate (IV MTX) plus IT. Triple intrathecal therapy (TIT) gave similar EFS but poorer survival than intrathecal methotrexate (IT MTX), but additional IV MTX improved both outcomes. One trial resulted in similar EFS and survival with IV MTX plus IT MTX versus TIT alone. Radiotherapy can generally be replaced by IT therapy. TIT should be used with effective systemic therapy such as IV MTX.
摘要
中枢神经系统（CNS）的治疗是儿童急性淋巴细胞白血病（ALL）的重要治疗组成部分。对 47 项试验中的 16 项 CNS 治疗比较的个体患者数据进行了分析。放疗与鞘内（IT）、放疗加 IT 与 IV 甲氨蝶呤（IV MTX）加 IT 的无事件生存（EFS）相似。三联鞘内治疗（TIT）的 EFS 相似，但生存率低于鞘内甲氨蝶呤（IT MTX），但额外的 IV MTX 改善了这两种结果。一项试验显示，IV MTX 加 IT MTX 与 TIT 单独治疗的 EFS 和生存率相似。放疗通常可以被 IT 治疗所替代。TIT 应与有效的全身治疗（如 IV MTX）联合使用。
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