Centro de Hematología y Medicina Interna, Clínica RUIZ, Puebla, Pue, Mexico; Benemérita Universidad Autónoma de Puebla, Puebla, Pue, Mexico.
Georgia Cancer Center. Augusta University, Augusta, GA, USA.
Leuk Res. 2022 Oct;121:106935. doi: 10.1016/j.leukres.2022.106935. Epub 2022 Aug 27.
The results of treatment of adolescents and adults with acute lymphoblastic leukemia (ALL) remain unsatisfactory. Pediatric-inspired treatments seem to be related with better outcomes. 126 adolescent and adult patients with ALL were treated in a 37-year period with a pediatric inspired combined chemotherapy (PICC) schedule, delivered on an outpatient basis and based on the St. Jude´s TOTAL XI pediatric protocol employing vincristine, prednisone, asparaginase, daunorubicin, etoposide, cytarabine, methotrexate, mercaptopurine and triple intrathecal therapy. 80 % of patients were able to receive the initial seven-week period of induction / consolidation fully as outpatients and 77 % achieved a complete remission. In adolescents and young adults (AYAs) the median probability of overall survival (OS) was 44 months, whereas the 5-year OS was 48 %. In adults, the median probability of OS was 24 months, and the 5-year OS was 32 %. Patients with T-cell ALL did significantly worse than those with a B cell phenotype (OS at 5 years 17 versus 40 %, respectively). These figures are better than those informed in our country employing more aggressive, in-hospital schedules such as the hyper-CVAD. We found that, in AYAs and adult patients with ALL, the use of an asparaginase-containing PICC delivered on an outpatient basis renders acceptable results, better than those obtained in similar socioeconomic circumstances employing adult-oriented schedules. Additional studies are needed to assess the usefulness of these PICC treatments in adult individuals with ALL treated in underprivileged circumstances, such as those prevailing in LMIC.
治疗青少年和成人急性淋巴细胞白血病（ALL）的结果仍不尽如人意。儿科启发的治疗方法似乎与更好的结果有关。在 37 年的时间里，126 名青少年和成人 ALL 患者接受了一种儿科启发的联合化疗（PICC）方案治疗，该方案在门诊基础上进行，并基于圣裘德的 TOTAL XI 儿科方案，使用长春新碱、泼尼松、门冬酰胺酶、柔红霉素、依托泊苷、阿糖胞苷、甲氨蝶呤、巯基嘌呤和三次鞘内治疗。80%的患者能够完全作为门诊患者接受最初的七周诱导/巩固治疗，77%的患者达到完全缓解。在青少年和年轻成人（AYAs）中，总生存（OS）的中位概率为 44 个月，而 5 年 OS 为 48%。在成年人中，OS 的中位概率为 24 个月，5 年 OS 为 32%。T 细胞 ALL 患者的预后明显差于 B 细胞表型患者（5 年 OS 分别为 17%和 40%）。这些数字优于我们国家采用更激进的住院方案（如 hyper-CVAD）所报告的数字。我们发现，在 ALL 的 AYAs 和成年患者中，使用含门冬酰胺酶的 PICC 进行门诊治疗可获得可接受的结果，优于在类似社会经济环境下采用成人导向方案所获得的结果。需要进一步研究评估这些 PICC 治疗在资源有限国家中接受治疗的 ALL 成年个体中的有用性，这些国家的条件往往较差。
