Matsuzaki A, Ishii E, Okamura J, Eguchi H, Yoshida N, Yanai F, Inoue T, Miyake K, Ishihara T, Tsuboi C
Department of Pediatrics, Kyushu University, Fukuoka, Japan.
Med Pediatr Oncol. 1996 Jan;26(1):10-9. doi: 10.1002/(SICI)1096-911X(199601)26:1<10::AID-MPO2>3.0.CO;2-Y.
A total of 125 children, who were diagnosed as having high-risk acute lymphoblastic leukemia (ALL), were treated with two consecutive protocols designated as AL851 (1985-1988) and ALHR88 (1988-1990). All patients received induction therapy consisting of vincristine (VCR), prednisolone (PSL), daunorubicin (DNR), and I-asparaginase (I-Asp). In the ALHR88 protocol, the patients whose blasts in the bone marrow (BM) were > or = 25% on day 14 of induction therapy and who were classified into T-cell type received additional cytosine arabinoside (AraC). After consolidation with intermediate-dose methotrexate (MTX), reinduction therapy including VCR, dexamethasone, and adriamycin followed by high-dose AraC was done for all patients. Intrathecal MTX and 24Gy of cranial irradiation were used to prevent central nervous system leukemia. A maintenance therapy consisting of 6-mercaptopurine, cyclophosphamide, MTX, DNR, VCR, and AraC was administered for 3 years after achieving a complete remission (CR). CR was achieved in 51/55 (92.7%) for AL851 and 68/70 (97.1%) for ALHR88. The 5-year event-free survival rates were 49.1 +/- 6.7% in AL851 and 62.5 +/- 6.1% in ALHR88. The factors related to a poor prognosis were a high initial leukocyte count of greater than 50 x 10(9)/L (P < 0.001), an L2 morphology of leukemic cells by FAB classification (P = 0.009), the chromosomal abnormality (P = 0.004) and high residual leukemic cells in BM (> or = 25%) on day 14 of induction therapy (P < 0.001). Taking these factors into consideration, more intensive protocols were started in 1990 for the patients with high-risk ALL.
共有125名被诊断为高危急性淋巴细胞白血病（ALL）的儿童接受了两个连续方案的治疗，这两个方案分别为AL851（1985 - 1988年）和ALHR88（1988 - 1990年）。所有患者均接受了由长春新碱（VCR）、泼尼松龙（PSL）、柔红霉素（DNR）和左旋门冬酰胺酶（I - Asp）组成的诱导治疗。在ALHR88方案中，诱导治疗第14天骨髓（BM）原始细胞≥25%且被分类为T细胞型的患者接受了额外的阿糖胞苷（AraC）治疗。在采用中剂量甲氨蝶呤（MTX）巩固治疗后，所有患者均进行了包括VCR、地塞米松和阿霉素在内的再诱导治疗，随后给予大剂量AraC。鞘内注射MTX和24Gy的颅脑照射用于预防中枢神经系统白血病。在达到完全缓解（CR）后，给予由6 - 巯基嘌呤、环磷酰胺、MTX、DNR、VCR和AraC组成的维持治疗3年。AL851方案中51/55（92.7%）的患者达到CR，ALHR88方案中68/70（97.1%）的患者达到CR。AL851方案的5年无事件生存率为49.1±6.7%，ALHR88方案为62.5±6.1%。与预后不良相关的因素包括初始白细胞计数高于50×10⁹/L（P < 0.001）、FAB分类中白血病细胞的L2形态（P = 0.009）、染色体异常（P = 0.004）以及诱导治疗第14天骨髓中残留白血病细胞≥25%（P < 0.001）。考虑到这些因素，1990年开始为高危ALL患者采用更强化的方案。
