Willemze R, Zijlmans J M, den Ottolander G J, Kluin-Nelemans J C, Falkenburg J H, Starrenburg C W, van der Burgh J F, Fibbe W E
Department of Hematology, Leiden University Medical Center, The Netherlands.
Ann Hematol. 1995 Feb;70(2):71-4. doi: 10.1007/BF01834382.
Thirty-two patients with untreated ALL (n = 26) or lymphoblastic lymphoma (n = 6) between 17 and 65 years of age were treated with a short remission induction course with VP16-213, amsacrine, intermediate dose Ara-C for 6 days, prednisone and intrathecal methotrexate, followed by a consolidation course with vincristine, amsacrine, high dose Ara-C for 4 days, prednisone and intrathecal methotrexate. After subsequent cranial irradiation, no further maintenance was planned. However, some patients underwent an allogenic (n = 5) or autologous (n = 5) bone marrow transplantation after the consolidation treatment. Twenty-three of 32 patients (72%) achieved a complete remission. Ten of 13 patients with T-ALL or lymphoma, six of eight patients with pre-B or common ALL, and seven of 11 patients with B-ALL or Burkitt's lymphoma achieved a complete remission. The median duration of remission was 24 months. Overall survival for the whole group was 35% at 5 years. The disease-free survival was 45% at 5 years. Long-term survival for patients with B or T-ALL was approximately 60%, compared with 15% for those with common or pre B-ALL. Short term intensive courses including intermediate or high dose Ara-C during remission and consolidation treatment lead to results comparable to those obtained with long-term maintenance regimens. Our regimen may be sufficient for patients with T or B-ALL. Larger randomized studies are needed to investigate the relative importance of our observations.
32例年龄在17至65岁之间未经治疗的急性淋巴细胞白血病（n = 26）或淋巴母细胞淋巴瘤（n = 6）患者接受了短期缓解诱导疗程，包括使用依托泊苷（VP16 - 213）、安吖啶、中剂量阿糖胞苷持续6天、泼尼松和鞘内注射甲氨蝶呤，随后是巩固疗程，使用长春新碱、安吖啶、高剂量阿糖胞苷持续4天、泼尼松和鞘内注射甲氨蝶呤。在后续的颅脑照射后，未计划进一步的维持治疗。然而，部分患者在巩固治疗后接受了异基因（n = 5）或自体（n = 5）骨髓移植。32例患者中有23例（72%）实现了完全缓解。13例T细胞急性淋巴细胞白血病或淋巴瘤患者中有10例、8例前B细胞或普通急性淋巴细胞白血病患者中有6例、11例B细胞急性淋巴细胞白血病或伯基特淋巴瘤患者中有7例实现了完全缓解。缓解的中位持续时间为24个月。整个组的5年总生存率为35%。无病生存率在5年时为45%。B或T细胞急性淋巴细胞白血病患者的长期生存率约为60%，相比之下，普通或前B细胞急性淋巴细胞白血病患者为15%。在缓解期和巩固治疗期间包括中或高剂量阿糖胞苷的短期强化疗程导致的结果与长期维持方案所获得的结果相当。我们的方案可能对T或B细胞急性淋巴细胞白血病患者足够。需要更大规模的随机研究来调查我们观察结果的相对重要性。
