Ribera J M, Grañena A, Rozman C, Urbano-Ispizua A, Bladé J, Carreras E, Cervantes F, Marín P, Sierra J, Nomdedeu B
Escuela de Hematología Farreras Valenti, Hospital Clínico y Provincial, Universidad de Barcelona.
Sangre (Barc). 1990 Feb;35(1):26-32.
The preliminary results of the LAL-86 protocol applied to 43 patients diagnosed of acute lymphoblastic leukaemia (ALL) or lymphoblastic lymphoma (LL) between May 1986 and April 1989 are reported. Induction treatment consisted of one or two courses of vincristine, daunorubicin, prednisone, cytosine arabinoside and 6-thioguanine combination therapy. This phase was followed by consolidation treatment, in which VM-26, cyclophosphamide, BCNU and L-asparaginase were added to the former agents. Central nervous system prophylaxis was done with intrathecal methotrexate. Patients under 45 years of age with HLA identical sibs were subjected to allogeneic bone marrow transplantation (BMT) in the first complete remission (CR); when no HLA-identical sibs were available patients were randomised into autologous BMT or maintenance therapy. The remaining patients received maintenance chemotherapy. CR was achieved in 34 ALL patients (79%), 5 were refractory to treatment and 4 died during remission induction. Allogeneic BMT was carried out in 6 cases, autologous BMT in 3, and the remainders received chemotherapy. When performing this review, 7 patients had relapsed and the actuarial probability of 2-year duration of CR was 70%. Sixteen patients have died with a two-year disease-free survival probability of 60%. The preliminary results of the LAL-86 protocol are encouraging, but greater number of patients is needed, as well as a longer follow-up, to assess the effect of chemotherapy and compare these findings to the results of autologous or allogeneic BMT in the first RC.
报告了1986年5月至1989年4月期间应用LAL - 86方案治疗43例诊断为急性淋巴细胞白血病（ALL）或淋巴细胞淋巴瘤（LL）患者的初步结果。诱导治疗包括一或两个疗程的长春新碱、柔红霉素、泼尼松、阿糖胞苷和6 - 硫鸟嘌呤联合治疗。此阶段之后是巩固治疗，即在先前药物基础上加用VM - 26、环磷酰胺、卡莫司汀和L - 天冬酰胺酶。采用鞘内注射甲氨蝶呤进行中枢神经系统预防。45岁以下有HLA相同同胞的患者在首次完全缓解（CR）时接受异基因骨髓移植（BMT）；当没有HLA相同同胞时，患者被随机分为自体BMT或维持治疗。其余患者接受维持化疗。34例ALL患者（79%）达到CR，5例治疗难治，4例在缓解诱导期死亡。6例进行了异基因BMT，3例进行了自体BMT，其余接受化疗。在进行本综述时，7例患者复发，CR持续2年的精算概率为70%。16例患者死亡，无病生存2年的概率为60%。LAL - 86方案的初步结果令人鼓舞，但需要更多患者以及更长时间的随访，以评估化疗效果并将这些结果与首次完全缓解时自体或异基因BMT的结果进行比较。
