悉生生物学措施在急性白血病治疗中的有效性：一项前瞻性随机临床研究结果

[Effectiveness of gnotobiotic measures in the treatment of acute leukemia: the results of a prospective randomized clinical study].

作者信息

Dietrich M, Abt C, Arnold R, Pflieger H, Hoelzer D, Kurrle E, Rasche H, Kubanek B, Heimpel H, Fliedner T M

出版信息

Onkologie. 1979 Jun;2(3):102-7. doi: 10.1159/000214484.

Abstract

60 adult patients with acute leukemia (AL) previously untreated or in relapse received induction chemotherapy with different types of supportive care. Group A was decontaminated by nonabsorbable antibiotics in strict reverse isolation, group B was isolated only and group C was treated under routine hospital conditions. There were less infections in group A and B compared with group C. 76% of patients in group A achieved remission, in contrast to 57% in group B and 59% in group C. Late evaluation three years after termination of the study showed that all patients were dead except four patients being in first remission after discontinuation of maintenance treatment. Three patients were treated in group A, one patient in group C. However, the differences of survival and remission rates were not significant. Failure to demonstrate significant advantage of isolation and decontamination in treatment of AL was caused by insufficient suppression of microbes by the applied antimicrobial measures. Thus, it is suggested to investigate better antimicrobial treatment before gnotobiotic care is accepted as routine supportive treatment in AL.

摘要

60例既往未接受过治疗或处于复发状态的成年急性白血病（AL）患者接受了不同类型支持治疗的诱导化疗。A组在严格的反向隔离中使用不可吸收抗生素进行去污处理，B组仅进行隔离，C组在常规医院条件下治疗。与C组相比，A组和B组的感染较少。A组76%的患者实现缓解，相比之下，B组为57%，C组为59%。研究结束三年后的后期评估显示，除4例在维持治疗中断后处于首次缓解状态的患者外，所有患者均死亡。A组有3例患者接受治疗，C组有1例患者接受治疗。然而，生存率和缓解率的差异并不显著。在AL治疗中未能证明隔离和去污有显著优势是由于所应用的抗菌措施对微生物的抑制不足。因此，建议在将无菌护理作为AL的常规支持治疗接受之前，研究更好的抗菌治疗方法。