Matsuzaki A, Ishii E, Ueda K, Yanai F, Nibu K, Take H, Koga H, Miyazaki S, Inoue T, Miyake K
Department of Pediatrics, Kyushu University.
Rinsho Ketsueki. 1994 Sep;35(9):862-70.
Fifty five children diagnosed as having high-risk acute lymphoblastic leukemia (ALL) between 1985 and 1988 were treated with protocol AL851. The agents used in the protocol were as follows: induction therapy: vincristine (VCR), prednisolone, daunorubicin (DNR) and l-asparaginase, consolidation therapy: an intermediate-dose methotrexate (MTX), central nervous system (CNS) leukemia prophylaxis: intrathecal MTX and 24Gy cranial irradiation, reinduction therapy: VCR, adriamycin, dexamethasone and high dose cytarabine (AraC), maintenance therapy: 6-mercaptopurine, cyclophosphamide, MTX, DNR, VCR and AraC. Patients received chemotherapy for 3 years after achieving complete remission (CR). CR was obtained in 51 patients (92.7%). Twenty-four of them relapsed after achieving CR (bone marrow 16, CNS 3 and testis 5). At median follow-up of 79 (range 64-102) months, the estimated 8-year disease free survival rate was 49.1 +/- 6.7%. Four patients relapsed at bone marrow during the first 6 months of the treatment, indicating that more intensive combination chemotherapy should be included in earlier stage of the protocol. The high incidence of testicular relapse (14.3% in boys) suggests that high-dose MTX or AraC should be needed for improvement of the prognosis of high-risk ALL patients.
1985年至1988年间，55名被诊断为高危急性淋巴细胞白血病（ALL）的儿童接受了AL851方案治疗。该方案使用的药物如下：诱导治疗：长春新碱（VCR）、泼尼松龙、柔红霉素（DNR）和L-天冬酰胺酶；巩固治疗：中剂量甲氨蝶呤（MTX）；中枢神经系统（CNS）白血病预防：鞘内注射MTX和24Gy颅脑照射；再诱导治疗：VCR、阿霉素、地塞米松和高剂量阿糖胞苷（AraC）；维持治疗：6-巯基嘌呤、环磷酰胺、MTX、DNR、VCR和AraC。患者在达到完全缓解（CR）后接受3年化疗。51例患者（92.7%）获得CR。其中24例在达到CR后复发（骨髓复发16例，CNS复发3例，睾丸复发5例）。在中位随访79个月（范围64 - 102个月）时，估计8年无病生存率为49.1±6.7%。4例患者在治疗的前6个月出现骨髓复发，这表明在方案的早期阶段应纳入更强化的联合化疗。睾丸复发的高发生率（男孩中为14.3%）表明，需要高剂量MTX或AraC来改善高危ALL患者的预后。
