Hiçsönmez G, Gümrük F, Zamani P V, Tuncer M A, Yetgin S, Gürgey A, Atahan L, Ozsoylu S
Department of Pediatric Hematology, Ihsan Dogramaci Children's Hospital, Ankara, Turkey.
Eur J Haematol. 1997 Jan;58(1):26-31. doi: 10.1111/j.1600-0609.1997.tb01406.x.
In an attempt to improve treatment outcome high-dose methylprednisolone (HDMP, 20-30 mg/kg, once a day orally) was used instead of a conventional dose of steroid (2 mg/kg/d, in 3 divided doses) in children with acute lymphoblastic leukemia (ALL) with increased risk factors. HDMP combined with cytotoxic agents (vincristine and L-asparaginase) resulted in an improved complete remission rate (94%) in 48 newly diagnosed children with ALL compared to 81% in 86 historical controls receiving standard dose steroid combined with the same treatment regimen. The bone marrow relapse rate was lower in patients who received HDMP (31%) than in controls (56%). Treatment was discontinued in 56% of 48 patients receiving HDMP and in 35% of 86 controls. The difference was significant (p < 0.05). The 5-yr continuous complete remission rate was significantly greater in patients received HDMP compared with the control patients (60% vs. 43%, p < 0.05). HDMP treatment was well tolerated without significant adverse effects. Moreover, during induction therapy the duration of leukopenia (< 2 x 10(9)/L) was shorter in patients receiving HDMP. We conclude that HDMP combined with other antileukemic agents increased the CR rate and prolonged the duration of remission in children with ALL who had increased risk factors. However, the optimal dosage of HDMP and its role in maintenance therapy should be determined in future, randomized studies.
为提高治疗效果，对于有高危因素的急性淋巴细胞白血病（ALL）患儿，采用大剂量甲泼尼龙（HDMP，20 - 30 mg/kg，每日口服1次）替代传统剂量的类固醇（2 mg/kg/d，分3次服用）。与86例接受标准剂量类固醇联合相同治疗方案的历史对照患儿相比，HDMP联合细胞毒性药物（长春新碱和L-天冬酰胺酶）使48例新诊断的ALL患儿的完全缓解率提高（94%），而历史对照患儿的完全缓解率为81%。接受HDMP治疗的患者骨髓复发率（31%）低于对照组（56%）。48例接受HDMP治疗的患者中有56%中断治疗，86例对照组中有35%中断治疗。差异有统计学意义（p < 0.05）。与对照组患者相比，接受HDMP治疗的患者5年持续完全缓解率显著更高（60%对43%，p < 0.05）。HDMP治疗耐受性良好，无明显不良反应。此外，在诱导治疗期间，接受HDMP治疗的患者白细胞减少（< 2×10⁹/L）的持续时间较短。我们得出结论，HDMP联合其他抗白血病药物可提高有高危因素的ALL患儿的完全缓解率并延长缓解期。然而，HDMP的最佳剂量及其在维持治疗中的作用应在未来的随机研究中确定。
