Meuret G
Schweiz Med Wochenschr. 1983 Sep 10;113(36):1289-93.
Better results have been achieved in the treatment of acute leukemia of adults by adaptation of therapeutic strategy to increased knowledge and to subtle differentiation of the various forms of the disease. The higher the resistance of leukemic blasts to chemotherapy, the more aggressive the induction therapy necessary to achieve favourable results. Intensive therapy produces a transient phase of bone marrow aplasia in which the patients must be protected by supportive care. Sensitivity to chemotherapy is relatively low in acute myelocytic leukemia. Therefore, the maximum tolerable dose of multi-drug chemotherapy is necessary to induce complete remissions (CR), which can be achieved in about 75% of patients under 65 years. Up to 40% remain in continuous remission longer than 3 years. The recurrence rate is high. Relapses are highly resistant to therapy, and therefore bone marrow transplantation is considered during the first CR. Most cases with acute lymphocytic leukemia are associated with higher sensitivity to chemotherapy. Less aggressive induction therapy in combination with maintenance therapy achieves CR in up to 85% of patients, about half of whom remain in continuous remission more than 3 years. Most of these cases can be regarded as cured.
通过使治疗策略适应对该疾病各种形式不断增加的认识和细微差异，成人急性白血病的治疗已取得了更好的效果。白血病原始细胞对化疗的耐药性越高，为取得良好疗效所需的诱导治疗就越积极。强化治疗会产生骨髓再生障碍的短暂阶段，在此阶段患者必须通过支持治疗来保护。急性髓细胞白血病对化疗的敏感性相对较低。因此，需要多药化疗的最大耐受剂量来诱导完全缓解（CR），65岁以下患者中约75%可实现这一目标。高达40%的患者可保持持续缓解超过3年。复发率很高。复发对治疗具有高度耐药性，因此在首次完全缓解期间会考虑进行骨髓移植。大多数急性淋巴细胞白血病病例对化疗的敏感性较高。不太积极的诱导治疗与维持治疗相结合，高达85%的患者可实现完全缓解，其中约一半患者可保持持续缓解超过3年。这些病例中的大多数可被视为治愈。
