Kawashima K, Nagura E, Yamada K, Hamajima N
Cancer. 1985 Jul 1;56(1):88-94. doi: 10.1002/1097-0142(19850701)56:1<88::aid-cncr2820560115>3.0.co;2-f.
Between 1964 and 1982, 862 patients with acute leukemia who were collected from medical institutions throughout the country had a survival of 5 years or longer. Their remission has been achieved mainly with a combination therapy of vincristine and prednisone in childhood acute leukemia and daunomycin, cytosine arabinoside, 6-mercaptopurine, prednisone (DCMP) regimen in adult acute leukemia. Among 320 relapsed patients, 88 (38.8%) of 227 children had a primary relapse in the marrow, 85 in the central nervous system (CNS), 37 in the testis/ovary, and 13 in a combined site. The large majority of adult relapsed patients relapsed in the marrow. Ninety-three patients who experienced only one relapse had a much longer prolongation of survival, not yet reaching a median over 14 years after diagnosis, compared to those experiencing two or more relapses. Survival curves in five groups of patients divided by length of maintained remission were investigated by the life table method. In children as well as adults, survival duration in patients on 5 or more years maintained remission was significantly longer than that in the other maintained groups. With respect to relation between frequency of CNS relapse and type of CNS prophylaxis, there was no statistically significant difference between patients who received CNS prophylaxis and patients who did not. However, a better survival was observed in patients who received CNS prophylaxis with cranial radiation plus intrathecal methotrexate. Thus, long-term clinical follow-up might provide important information for the therapeutic strategy against acute leukemia.
1964年至1982年间，从全国医疗机构收集的862例急性白血病患者存活了5年或更长时间。儿童急性白血病的缓解主要通过长春新碱和泼尼松的联合治疗实现，成人急性白血病则采用柔红霉素、阿糖胞苷、6-巯基嘌呤、泼尼松（DCMP）方案。在320例复发患者中，227例儿童中有88例（38.8%）首次复发发生在骨髓，85例发生在中枢神经系统（CNS），37例发生在睾丸/卵巢，13例发生在联合部位。大多数成人复发患者在骨髓复发。与经历两次或更多次复发的患者相比，仅经历一次复发的93例患者的生存期延长了很多，诊断后尚未达到中位数超过14年。采用寿命表法研究了按缓解维持时间分组的五组患者的生存曲线。在儿童和成人中，缓解维持5年或更长时间的患者的生存期明显长于其他缓解维持组。关于CNS复发频率与CNS预防类型之间的关系，接受CNS预防的患者与未接受CNS预防的患者之间没有统计学上的显著差异。然而，接受颅脑放疗加鞘内甲氨蝶呤CNS预防的患者观察到更好的生存情况。因此，长期临床随访可能为急性白血病的治疗策略提供重要信息。
