Jacobs P, Wood L, Novitzky N
University of Cape Town Leukaemia Centre, South Africa.
Haematol Blood Transfus. 1990;33:428-31. doi: 10.1007/978-3-642-74643-7_79.
Eighty-five consecutive patients with acute lymphoblastic leukaemia (ALL), having a median age of 24 years (range 10-69 years), underwent induction and consolidation chemotherapy with weekly parenteral vincristine, Adriamycin, l-asparaginase and daily oral prednisone (VAAP), followed by standard (CNS) prophylaxis. Maintenance therapy was given for 3 years and consisted of daily 6-mercaptopurine, weekly methotrexate and monthly intrathecal therapy, with drug intensification comprising either vincristine, Adriamycin and l-asparaginase (VAA) or cyclophosphamide, vincristine, cytosine arabinoside and prednisone (COAP). Complete remission (CR) was obtained in 59 patients (69%) and only the French-American-British (FAB) L1 morphology was a significant predictive factor (P = 0.048). Twenty-three patients failed to achieve CR and of these 12 had primary drug resistance. Median follow-up is currently 260 weeks, median predicted survival of all patients is 58 weeks and for those who achieved CR it is 104 weeks. Median duration of CR is 70 weeks. Of the prognostic factors for survival, only FAB L1 subtype was significant. Bone marrow relapses occurred in 29 patients, and of these 9 (31%) achieved CR. There has been CNS relapse in two patients and both have died. Eleven patients continue in CR off therapy, with a median of 152 weeks. This regimen is effective, with acceptable toxicity, and a number of patients are potentially cured. The incidence of resistant and relapsing disease is an argument for further intensifying both induction and postinduction therapy.
85例急性淋巴细胞白血病（ALL）患者连续入组，年龄中位数为24岁（范围10 - 69岁），接受了每周一次的静脉注射长春新碱、阿霉素、左旋门冬酰胺酶及每日口服强的松（VAAP）进行诱导和巩固化疗，随后进行标准的（中枢神经系统）预防治疗。维持治疗为期3年，包括每日口服6-巯基嘌呤、每周一次甲氨蝶呤及每月一次鞘内治疗，药物强化治疗包括长春新碱、阿霉素和左旋门冬酰胺酶（VAA）或环磷酰胺、长春新碱、阿糖胞苷及强的松（COAP）。59例患者（69%）获得完全缓解（CR），仅法国-美国-英国（FAB）L1形态是一个显著的预测因素（P = 0.048）。23例患者未达到CR，其中12例有原发性耐药。目前中位随访时间为260周，所有患者的中位预测生存期为58周，达到CR的患者为104周。CR的中位持续时间为70周。在生存的预后因素中，只有FAB L1亚型具有显著性。29例患者发生骨髓复发，其中9例（31%）再次获得CR。2例患者发生中枢神经系统复发，均已死亡。11例患者在停止治疗后仍处于CR状态，中位时间为152周。该方案有效，毒性可接受，许多患者有潜在治愈可能。耐药和复发性疾病的发生率表明需要进一步加强诱导和诱导后治疗。
