Ortega J J, Javier G
An Esp Pediatr. 1981 Oct;15(4):357-64.
Sixty-one children with ALL were treated between 1970 an 1973 according to a scheme including: a) Remission induction with vincristine-prednisolone-daunorubicine. b) Cytoreduction therapy with 4 drugs (6-MP, MTX,Ara-C and CYCLO) combined two by two in 3 types of associations given at three months cycles. Every three months, two-week "reinductions" with vincristine and prednisolone plus one dose of i.t. MTX. c) Early therapy on CNS, according to two patterns: one group received one dose of i.t. MTX after induction, repeated every 3 months; the other group was given cranial irradiation [2,400 r] plus 5 doses of i.t. MTX. d) After three years of chemotherapy, patients were treated for two more years with BCG by scarification.
Complete remission was achieved in 93%. After three years of chemotherapy, 37% of the first group (not irradiated) and 55% of the second (irradiated) persisted in C.R. Twenty-five patients initiated BCG-therapy; eighteen of these (72%) persisted, after 2 years, in C.R.; then all treatment was suppressed. Initial relapses in the 5 years period were hematological in 13, CNS in 13, both hematological and CNS in 2, and testicular in 3. Mortality of patients in C.R. was 4 (7.7%). Survival rates were 33% after 5 years for the non-irradiated group and 50% in the irradiated one. At present, 30% of all evaluable patients who attained remission continue in C.R. after an average time of 102 months-40% in the irradiated group and 20% in the not irradiated-. This difference, statistically significant, is due to the number of CNS relapses: 13 of 30 (43%) in the first group and 3 of 22 (13.1%) in the second. The 24% relapses occurring during immunotherapy do not permit to assess the efficacy of this form of therapy.
1970年至1973年间，61名急性淋巴细胞白血病患儿接受了如下治疗方案：a) 采用长春新碱-泼尼松-柔红霉素进行缓解诱导。b) 采用4种药物（6-巯基嘌呤、甲氨蝶呤、阿糖胞苷和环磷酰胺）进行细胞减灭治疗，将这4种药物两两组合成3种联合用药方式，每3个月为一个周期。每3个月，用长春新碱和泼尼松进行为期两周的“再诱导”，并加一剂鞘内注射甲氨蝶呤。c) 根据两种模式对中枢神经系统进行早期治疗：一组在诱导后接受一剂鞘内注射甲氨蝶呤，每3个月重复一次；另一组接受颅脑照射[2400拉德]加5剂鞘内注射甲氨蝶呤。d) 化疗三年后，患者通过划痕接种卡介苗再治疗两年。
93%的患者实现完全缓解。化疗三年后，第一组（未接受照射）37%的患者和第二组（接受照射）55%的患者持续完全缓解。25名患者开始接受卡介苗治疗；其中18名（72%）患者在两年后持续完全缓解；随后停止所有治疗。5年期间的初始复发情况为：血液学复发13例，中枢神经系统复发13例，血液学和中枢神经系统均复发2例，睾丸复发3例。完全缓解患者的死亡率为4例（7.7%）。未接受照射组5年后的生存率为33%，接受照射组为50%。目前，所有达到缓解的可评估患者中，30%在平均102个月后仍持续完全缓解——照射组为40%，未照射组为20%。这种差异具有统计学意义，原因在于中枢神经系统复发的数量：第一组30例中有13例（43%），第二组22例中有3例（13.1%）。免疫治疗期间出现的24%的复发情况无法评估这种治疗方式的疗效。
