Jenney M E, Faragher E B, Jones P H, Woodcock A
Royal Manchester Children's Hospital, Oncology Unit, Pendlebury, England.
Med Pediatr Oncol. 1995 Apr;24(4):222-30. doi: 10.1002/mpo.2950240403.
The survival from acute lymphoblastic leukaemia in childhood is now approximately 60-70%, and from acute myeloid leukaemia, up to 50%. However, there is little information on the effects of intensive chemotherapy and radiotherapy used in the treatment of these conditions on lung function and exercise capacity in the long term. Severity survivors of acute leukaemia from one centre in the UK were studied. Measurements of lung volumes, spirometry and transfer factor were made. Each child also performed a standard, symptom-limited maximal exercise test on a cycle ergometer. Predictive equations for indices of lung function and exercise tolerance were calculated from 146 age- and sex-matched control subjects. The results of the survivors of leukaemia were compared to these. There was a significant reduction of forced expiratory volume in one second (FEV1), forced vital capacity (FVC), total lung capacity (TLC), and transfer for carbon monoxide (DLCO; P < 0.05 for each measurement), in the survivors of leukemia when compared to the control subjects. In addition, there was a mild but significant reduction of both maximal and submaximal indices of exercise capacity in the leukaemic group. A multivariate analysis was carried out to identify those variables acting independently to reduce lung volumes. For FEV1, FVC and TLC, these were craniospinal irradiation, cyclophosphamide and chest complications during treatment. For a reduction in DLCO, the significant factors were administration of anthracyclines, craniospinal irradiation and bone marrow transplantation. Survivors of acute leukemia have impaired pulmonary function and exercise capacity. Long-term cardiopulmonary follow-up may be necessary and new regimens devised which reduce long-term toxicity without compromising survival rates.
儿童急性淋巴细胞白血病的生存率目前约为60%-70%，急性髓细胞白血病的生存率高达50%。然而，关于用于治疗这些疾病的强化化疗和放疗对肺功能和运动能力的长期影响，相关信息较少。对英国一个中心的急性白血病严重程度幸存者进行了研究。测量了肺容积、肺量计和转移因子。每个孩子还在自行车测力计上进行了标准的、症状限制的最大运动测试。根据146名年龄和性别匹配的对照受试者计算了肺功能和运动耐力指标的预测方程。将白血病幸存者的结果与这些对照进行比较。与对照受试者相比，白血病幸存者的一秒用力呼气量（FEV1）、用力肺活量（FVC）、肺总量（TLC）和一氧化碳转移（DLCO；每次测量P<0.05）均显著降低。此外，白血病组的最大和次最大运动能力指标均有轻度但显著的降低。进行了多变量分析，以确定那些独立作用以减少肺容积的变量。对于FEV1、FVC和TLC，这些变量是全脑脊髓照射、环磷酰胺和治疗期间的胸部并发症。对于DLCO降低，显著因素是蒽环类药物的使用、全脑脊髓照射和骨髓移植。急性白血病幸存者的肺功能和运动能力受损。可能需要进行长期心肺随访，并设计新的方案，在不影响生存率的情况下降低长期毒性。
