Niethammer D, Klingebiel T, Ebell W, Henze G, Paolucci P, Riehm H
Dept. of Paediatrics, Univ. of Tübingen, Germany.
Bone Marrow Transplant. 1996 Nov;18 Suppl 2:43-6.
The development of chemotherapy in childhood ALL has been the leader of the success story of paediatric oncology. At least 2/3 of the children can be cured nowadays at the first attempt of treatment. From the remaining again 1/3 can be treated successfully for the relapse of their disease with conventional therapeutic strategies. This means, however, that there is no chance for cure with chemotherapy alone for 20 to 25% of the children. BMT has been shown for a long time to be an alternative therapy especially in those cases in which conventional chemotherapy fails. In spite of the fact that many children with ALL have been transplanted during recent years there is still no general agreement on the question which children need BMT. However a few statements can be made: The value of ABMT in ALL is probably not better than that of chemotherapy alone. In 1st CR a group of children can be defined, which might benefit from BMT. In 2nd CR the value of chemotherapy depends very much from the duration of 1st remission. Allogeneic BMT is the only chance for cure in very early relapses, superior to chemotherapy in early and late relapses and possibly equal to chemotherapy in very late relapses. The paper tries to summarise our current knowledge about the situation.
儿童急性淋巴细胞白血病（ALL）化疗的发展一直是儿科肿瘤学成功故事的引领者。如今，至少三分之二的儿童在首次治疗尝试时就能被治愈。对于其余三分之一疾病复发的儿童，采用传统治疗策略仍可成功治疗。然而，这意味着有20%至25%的儿童仅靠化疗没有治愈的机会。长期以来，骨髓移植（BMT）一直被证明是一种替代疗法，特别是在那些传统化疗失败的病例中。尽管近年来许多ALL患儿接受了移植，但对于哪些儿童需要BMT这个问题仍未达成普遍共识。不过，可以做出一些陈述：自体骨髓移植（ABMT）在ALL中的价值可能并不比单纯化疗更好。在首次完全缓解（1st CR）时，可以确定一组可能从BMT中获益的儿童。在第二次完全缓解（2nd CR）时，化疗的价值很大程度上取决于首次缓解期的时长。异基因骨髓移植是极早期复发时唯一的治愈机会，在早期和晚期复发时优于化疗，在极晚期复发时可能与化疗相当。本文试图总结我们目前对这种情况的认识。
