Advani S H, Rao D N, Gopal R, Nair C N, Battacharya M
Am J Hematol. 1983 Aug;15(1):35-43. doi: 10.1002/ajh.2830150105.
Acute Lymphatic Leukemia (ALL) patients seen during the period 1974-1978 at the Tata Memorial Hospital. Bombay, are analyzed retrospectively to evaluate the clinical features at presentation, results of sequential therapy, and prognostic factors. A total of 301 patients were registered during the study period. There were 153 evaluable patients. Of these 73 patients received induction therapy with vincristine and prednisolone (VP) followed by cranial prophylaxis (cranial radiotherapy, 2,400 rads, and 10 weekly intrathecal injections of methotrexate 7.5 mg/m20 and continuous oral maintenance with daily 6-mercaptopurine and weekly methotrexate (group A). Another 39 patients (group B) received pulse therapy with vincristine and prednisolone during maintenance therapy. Finally 41 patients (group C) received L-asparaginase during induction and pulse therapy in addition to drugs as in group A. Of the 153 patients, 88 (58%) achieved complete response after induction treatment. Induction remission was 53% with vincristine and prednisolone (group A and group B), whereas it was 70% in group C. The difference in complete response rate in group C was statistically significant (P less than 0.05). The 3-year survival in our series was 22%, with median survival of 11 months. Group C patients receiving L-asparaginase along with vincristine and prednisolone showed 41% 3-year survival compared to 16% for group B. The 3-year survival in group A patients was only 7%, probably owing to lack of pulse therapy during maintenance treatment. The prognostic factors such as age, sex, WBC count, and mediastinal node were compared for induction remission and total survival. Possible factors relating to poor results in our series as compared to developed countries are discussed.
对1974年至1978年期间在孟买塔塔纪念医院就诊的急性淋巴细胞白血病（ALL）患者进行回顾性分析，以评估其就诊时的临床特征、序贯治疗结果及预后因素。研究期间共登记了301例患者，其中153例可评估。这153例患者中，73例接受长春新碱和泼尼松（VP）诱导治疗，随后进行颅脑预防（颅脑放疗，2400拉德，每周10次鞘内注射甲氨蝶呤7.5毫克/平方米，每日口服6-巯基嘌呤并每周口服甲氨蝶呤进行持续维持治疗（A组）。另外39例患者（B组）在维持治疗期间接受长春新碱和泼尼松脉冲治疗。最后41例患者（C组）在诱导和脉冲治疗期间除使用A组药物外还接受了L-天冬酰胺酶治疗。153例患者中，88例（58%）在诱导治疗后达到完全缓解。长春新碱和泼尼松治疗组（A组和B组）的诱导缓解率为53%，而C组为70%。C组完全缓解率的差异具有统计学意义（P小于0.05）。本系列研究中3年生存率为22%，中位生存期为11个月。接受L-天冬酰胺酶联合长春新碱和泼尼松治疗的C组患者3年生存率为41%，而B组为16%。A组患者的3年生存率仅为7%，可能是由于维持治疗期间缺乏脉冲治疗。比较了年龄、性别、白细胞计数和纵隔淋巴结等预后因素对诱导缓解和总生存的影响。讨论了与发达国家相比本系列研究结果不佳的可能相关因素。
