Ortega Aramburu J J, Javier G, Sáenz A, Tusell J
An Esp Pediatr. 1976 Jun;9(4 Suppl):49-54.
61 consecutive children having A.L.L., were treated, between 1970 and 1974, according to a chemotherapy protocol including: 1. Induction treatment with prednisolone, vincristine and daunorubicine. 2. Maintenance therapy using three types of two drugs combinations, administered by cycles of three months duration each one. The associations were: mercaptopurine-methotrexate, mercaptopurine-cytosine arabinoside and methotrexate-cyclophosphamide. Between cycles, "reinductions" with prednisolone and vincristine of two weeks duration were given. 3. "Prophylactic" treatment of CNS leukemia was administered according to two modalities: a) In group named C-1, 32 patients received one dose of i.t. methotrexate at the end of the induction treatment and every three months. b) The other 29 patients (C-2 group) were treated by cranial irradiation (2400 r.) and five doses of i.t. methotrexate, after the induction of remission (C.R.).
57 out of 61 patients (93%) attained C.R. Twelve months after induction of C.R., in C-1 group, one patient died by infectious disease and eight relapsed. Twenty (68%) remained in C.R. The number of CNS relapses in this period was six (20%). In C-2 group, from 21 evaluable cases, 18 children (85%) were in C.R. at the end of first year and relapses in CNS were only two (9%). The median duration of remission in the first group was about three years. Percentage of cases with CNS relapses in three years was 35%. At the end of 4 th. year 37% remained in the initial C.R.-80% of the evaluable patients receiving cranial irradiation persisted in remission at the end of the second year. Efficacity of the prophylactic treatment of CNS infiltration, by cranial irradiation and i.t. chemotherapy is confirmed. Cyclic use of several combinations of drugs don't appear to be superior to the use of one single association (MP-MTX), but other combinations used here may be taken in account in cases of severe intolerance to one of these drugs.
1970年至1974年间，61名患有急性淋巴细胞白血病（A.L.L.）的儿童按照如下化疗方案接受治疗：1. 用泼尼松龙、长春新碱和柔红霉素进行诱导治疗。2. 维持治疗采用三种两种药物联合的方式，每种联合治疗为期三个月为一个周期。联合用药方案为：巯基嘌呤 - 甲氨蝶呤、巯基嘌呤 - 阿糖胞苷以及甲氨蝶呤 - 环磷酰胺。在两个周期之间，给予为期两周的泼尼松龙和长春新碱“再诱导”治疗。3. 中枢神经系统白血病的“预防性”治疗按两种方式进行：a）在名为C - 1组的32名患者中，在诱导治疗结束时及之后每三个月接受一次鞘内注射甲氨蝶呤。b）另外29名患者（C - 2组）在诱导缓解（完全缓解，C.R.）后接受颅脑照射（2400伦琴）和五次鞘内注射甲氨蝶呤。
61名患者中有57名（93%）达到完全缓解。在完全缓解诱导后的12个月，C - 1组中，1名患者死于传染病，8名复发。20名（68%）仍处于完全缓解状态。此期间中枢神经系统复发的数量为6例（20%）。在C - 2组中，从21例可评估病例来看，18名儿童（85%）在第一年末处于完全缓解状态，中枢神经系统复发仅2例（9%）。第一组的缓解中位持续时间约为三年。三年中枢神经系统复发病例的百分比为35%。在第四年末，37%仍处于初始完全缓解状态——接受颅脑照射的可评估患者中有80%在第二年末持续缓解。颅脑照射和鞘内化疗对中枢神经系统浸润的预防性治疗效果得到证实。几种药物联合的循环使用似乎并不优于单一联合用药（巯基嘌呤 - 甲氨蝶呤），但对于对其中一种药物严重不耐受的情况，这里使用的其他联合用药方案可予以考虑。
