Graubner U B, Haas R J, Janka G, Gaedicke G, Kohne E, Rieber E P
Klin Padiatr. 1985 May-Jun;197(3):207-14. doi: 10.1055/s-2008-1033970.
149 children with acute lymphocytic leukemia (ALL) were admitted to a prospective therapeutic regime. Remission induction was achieved by vincristine, daunorubicine, L-asparaginase and prednisone. During consolidation the patients received three intermediate dose methotrexate (MTX) infusions over 24 hours combined with intrathecal MTX, followed by L-asparaginase. High-risk patients were treated in addition with high dose cyclophosphamide and ARA-C over 3 weeks. Standard risk patients received cranial irradiation with 18 Gy, high-risk patients with 24 Gy. Maintenance therapy was performed with 6-mercaptopurine and MTX orally. Immunologic phaenotyping revealed: c-ALL 73%, pre-T or T-ALL 15%, c/T-ALL 4% and undifferentiated leukemia (AUL) 8%. Only 1 patient was nonresponder, 7 patients died during induction therapy, 5 patients during continuous complete remission (CCR). 18 relapses occurred, 12 of which were systemic, 8 CNS and 2 testicular relapses. In the total group the 54 months probability of CCR is 0,68 +/- 0,05 (life-table-analysis), for the reduced group 0,75 +/- 0,05. In the reduced group the probability of CCR at 54 months for standard risk patients is 0,86 +/- 0,06; for high-risk patients 0,60 +/- 0,09; for patients with c-ALL 0,73 +/- 0,08; for patients with c/T-ALL 1,0 +/- 0,0; for patients with pre-T or T-ALL 0,58 +/- 0,2 and for patients with AUL 0,45 +/- 0,25. For the reduced group the CCR probability at 54 months in relation to the leukocytes (WBC) at diagnosis is in patients with WBC less than 25 X 10(3)/mm3: 0,80 +/- 0,06; for patients with WBC greater than 25 X 10(3)/mm3: 0,63 +/- 0,11.
149名急性淋巴细胞白血病（ALL）患儿纳入一项前瞻性治疗方案。通过长春新碱、柔红霉素、L-天冬酰胺酶和泼尼松实现缓解诱导。巩固治疗期间，患者在24小时内接受三次中等剂量甲氨蝶呤（MTX）输注，并联合鞘内注射MTX，随后使用L-天冬酰胺酶。高危患者另外接受为期3周的大剂量环磷酰胺和阿糖胞苷治疗。标准风险患者接受18 Gy的颅脑照射，高危患者接受24 Gy的颅脑照射。维持治疗采用口服6-巯基嘌呤和MTX。免疫表型分析显示：普通型ALL（c-ALL）73%，前T或T-ALL 15%，c/T-ALL 4%，未分化白血病（AUL）8%。仅1例患者无反应，7例患者在诱导治疗期间死亡，5例患者在持续完全缓解（CCR）期间死亡。发生18例复发，其中12例为全身性复发，8例为中枢神经系统复发，2例为睾丸复发。在整个组中，CCR的54个月概率为0.68±0.05（生命表分析），在缩减组中为0.75±0.05。在缩减组中，标准风险患者54个月时的CCR概率为0.86±0.06；高危患者为0.60±0.09；c-ALL患者为0.73±0.08；c/T-ALL患者为1.0±0.0；前T或T-ALL患者为0.58±0.2，AUL患者为0.45±0.25。对于缩减组，54个月时CCR概率与诊断时白细胞（WBC）的关系为：WBC小于25×10³/mm³的患者为0.80±0.06；WBC大于25×10³/mm³的患者为0.63±0.11。
