Finlay J L, Anderson J R, Cecalupo A J, Hutchinson R J, Kadin M E, Kjeldsberg C R, Provisor A J, Woods W G, Meadows A T
Memorial Sloan-Kettering Cancer Center, New York, New York.
Med Pediatr Oncol. 1994;23(6):453-63. doi: 10.1002/mpo.2950230602.
To assess the efficacy of a chemotherapy-only regimen in pediatric patients with disseminated non-lymphoblastic lymphoma and acute B-cell leukemia (B-ALL).
Sixty-eight eligible patients with previously untreated disseminated non-lymphoblastic lymphoma were enrolled on a Childrens Cancer Group study. Therapy included cycles of chemotherapy, systemic and intrathecal (IT), ever 3 weeks for a total maximal duration of 57 weeks. Fifty-five patients had small non-cleaved cell lymphoma (SNCCL) and 13 had diffuse large cell lymphoma (DLCL). Forty-seven were stage III, six were stage IV, and 15 had B-ALL; 13 had central nervous system (CNS) involvement.
Four year event-free survival (EFS) was 53% (SE +/- 12%). Stage III SNCCL patients with LDH < 500 IU/L achieved an improved EFS compared to other SNCCL patients (86% vs. 42% 4 year EFS, P = .072). The primary site of failure for advanced stage SNCCL patients was the CNS. All Ki-1-positive DLCL patients relapsed. Patterns of failure, time to relapse, and outcome following relapse differed between SNCCL and DLCL patients.
Advanced stage SNCCL requires better CNS-directed chemotherapy to reduce the CNS failure rate; however, the achievement of durable disease-free survival in four of 11 patients with CNS disease without use of cranial irradiation suggests merit for further evaluation of chemotherapy-only strategies. DLCL patients do not need intensive CNS-directed chemotherapy.
评估单纯化疗方案对患有播散性非淋巴细胞淋巴瘤和急性B淋巴细胞白血病（B-ALL）的儿科患者的疗效。
68例符合条件的既往未接受过治疗的播散性非淋巴细胞淋巴瘤患者参加了儿童癌症组的一项研究。治疗包括每3周进行一轮全身和鞘内化疗，最长持续57周。55例患者为小无裂细胞淋巴瘤（SNCCL），13例为弥漫性大细胞淋巴瘤（DLCL）。47例为III期，6例为IV期，15例患有B-ALL；13例有中枢神经系统（CNS）受累。
4年无事件生存率（EFS）为53%（标准误±12%）。与其他SNCCL患者相比，乳酸脱氢酶（LDH）<500 IU/L的III期SNCCL患者的EFS有所改善（4年EFS为86%对42%，P = 0.072）。晚期SNCCL患者的主要失败部位是中枢神经系统。所有Ki-1阳性的DLCL患者均复发。SNCCL和DLCL患者在失败模式、复发时间和复发后的结局方面存在差异。
晚期SNCCL需要更好的针对中枢神经系统的化疗以降低中枢神经系统失败率；然而，11例患有中枢神经系统疾病的患者中有4例在未进行颅脑照射的情况下实现了持久的无病生存，这表明单纯化疗策略值得进一步评估。DLCL患者不需要强化的针对中枢神经系统的化疗。
