Toogood I R, Tiedemann K, Stevens M, Smith P J
Adelaide Medical Centre for Women and Children, Children's Hospital Division, North Adelaide, South Australia.
Med Pediatr Oncol. 1993;21(2):103-10. doi: 10.1002/mpo.2950210205.
Between June 1981 and May 1988, 51 children with diffuse undifferentiated, advanced (Murphy Stage III and IV) intra-abdominal non-Hodgkin's lymphoma were treated on an intensive multi-drug chemotherapy protocol without irradiation to the primary tumour. Therapy was completed for Stage III disease at one year, but Stage IV patients continued with a further year of therapy until January 1986, when it was reduced to one year. Central nervous system (CNS) prophylaxis consisted of eight doses of intrathecal MTX for all children, and 24 Gy cranial irradiation for Stage IV patients only. There were 42 patients with Stage III disease (III A n = 29 and III B n = 13) and nine patients with Stage IV disease, of whom eight had extensive bone marrow and extramedullary disease (FAB L3 ALL). No patient had CNS disease at presentation. Forty-eight of 51 children (94%) achieved a complete remission. Two children died during remission induction therapy and eleven children relapsed, mostly within eight months of diagnosis. All patients have completed therapy. Failure free survival is 76% for Stage III and 67% for Stage IV patients, with a median followup of 90 and 64 months, respectively. Subdividing Stage III patients into Stage III A and III B did not show significantly different survival (P = 0.9), but the number of patients in Stage III B is small. These results compare favourably with the most effective published protocols, and toxicity has been manageable.
1981年6月至1988年5月期间，51例患有弥漫性未分化、晚期（墨菲Ⅲ期和Ⅳ期）腹腔内非霍奇金淋巴瘤的儿童接受了强化多药化疗方案，未对原发肿瘤进行放疗。Ⅲ期疾病的治疗在1年内完成，但Ⅳ期患者继续接受1年的进一步治疗，直到1986年1月，治疗时间减至1年。中枢神经系统（CNS）预防措施包括对所有儿童鞘内注射8剂甲氨蝶呤，仅对Ⅳ期患者进行24 Gy的颅脑照射。有42例Ⅲ期疾病患者（ⅢA期n = 29，ⅢB期n = 13）和9例Ⅳ期疾病患者，其中8例有广泛的骨髓和髓外疾病（FAB L3 ALL）。所有患者就诊时均无CNS疾病。51例儿童中有48例（94%）实现完全缓解。2例儿童在缓解诱导治疗期间死亡，11例儿童复发，大多在诊断后8个月内复发。所有患者均已完成治疗。Ⅲ期患者的无失败生存率为76%，Ⅳ期患者为67%，中位随访时间分别为90个月和64个月。将Ⅲ期患者细分为ⅢA期和ⅢB期，生存率无显著差异（P = 0.9），但ⅢB期患者数量较少。这些结果与已发表的最有效的方案相比具有优势，且毒性可控。
