Bowman W P, Shuster J J, Cook B, Griffin T, Behm F, Pullen J, Link M, Head D, Carroll A, Berard C, Murphy S
Cook Children's Medical Center, Department of Hematology/Oncology, Fort Worth, TX, USA.
J Clin Oncol. 1996 Apr;14(4):1252-61. doi: 10.1200/JCO.1996.14.4.1252.
In an effort to improve outcome for children with advanced B-cell malignancies, a treatment plan based on a published regimen that consists of four courses of fractionated cyclophosphamide (cyclo) given with doxorubicin (doxo) and vincristine (VCR) was intensified by alternating with sequential high-dose methotrexate (MTX) and cytarabine (Ara-C), given in conjunction with intrathecal (IT) MTX and Ara-C.
From October 1986 to October 1992, 133 eligible patients were enrolled: 74 with B-cell (surface immunoglobulin-positive [Slg+] acute lymphoblastic leukemia (B-ALL) and 59 with stage IV small noncleaved-cell lymphoma (SNCCL). The median age was 8 years; there were 103 males and 30 females. Abdominal tumor masses were prominent in 63 cases (33 B-ALL and 30 stage IV SNCCL).
Complete remission (CR) was achieved in 66 B-ALL and 57 stage IV patients (93% overall). At 4 years, the estimated event-free survival (EFS) rate is 65% +/- 8% for patients with B-ALL and 79% +/- 9% for those with stage IV SNCCL. Among patients with CNS involvement, 23 of 36 remain in CR (4-year EFS rate, 64% +/- 13%). Relapses occurred early; only 3 patients relapsed after completion of therapy. Thirteen relapses occurred in the marrow, three in the CNS, and six in other sites. Of 11 CNS-positive patients who relapsed, only two recurred primarily in the CNS.
The results of this study indicate that with intensified chemotherapy an increasing potential for cure exists for patients with B-ALL and stage IV SNCCL.
为了改善晚期B细胞恶性肿瘤患儿的治疗效果，基于一种已发表的治疗方案制定了一项治疗计划，该方案包括四个疗程的分次环磷酰胺（环磷酰胺）联合阿霉素（阿霉素）和长春新碱（VCR），并通过交替使用序贯大剂量甲氨蝶呤（MTX）和阿糖胞苷（Ara-C）进行强化，同时联合鞘内注射（IT）MTX和Ara-C。
1986年10月至1992年10月，共纳入133例符合条件的患者：74例B细胞（表面免疫球蛋白阳性[Slg+]急性淋巴细胞白血病（B-ALL））和59例IV期小无裂细胞淋巴瘤（SNCCL）。中位年龄为8岁；男性103例，女性30例。63例（33例B-ALL和30例IV期SNCCL）腹部肿瘤肿块明显。
66例B-ALL患者和57例IV期患者实现完全缓解（CR）（总体缓解率93%）。4年时，B-ALL患者的无事件生存率（EFS）估计为65%±8%，IV期SNCCL患者为79%±9%。在中枢神经系统受累的患者中，36例中有23例仍处于CR状态（4年EFS率，64%±13%）。复发较早；仅3例患者在治疗完成后复发。13例复发发生在骨髓，3例发生在中枢神经系统，6例发生在其他部位。在11例复发的中枢神经系统阳性患者中，只有两例主要在中枢神经系统复发。
本研究结果表明，通过强化化疗，B-ALL和IV期SNCCL患者的治愈潜力不断增加。
