成人急性淋巴细胞白血病缓解后强化化疗且无维持治疗。荷兰血液肿瘤研究组。

Intensive postremission chemotherapy without maintenance therapy in adults with acute lymphoblastic leukemia. Dutch Hemato-Oncology Research Group.

作者信息

Dekker A W, van't Veer M B, Sizoo W, Haak H L, van der Lelie J, Ossenkoppele G, Huijgens P C, Schouten H C, Sonneveld P, Willemze R, Verdonck L F, van Putten W L, Löwenberg B

机构信息

Department of Hematology, University Hospital Utrecht, the Netherlands.

出版信息

J Clin Oncol. 1997 Feb;15(2):476-82. doi: 10.1200/JCO.1997.15.2.476.

DOI:10.1200/JCO.1997.15.2.476

PMID:9053468

Abstract

PURPOSE

To investigate the value of intensive consolidation chemotherapy not followed by maintenance therapy in adult acute lymphoblastic leukemia (ALL).

MATERIALS AND METHODS

A multicenter phase II trial was conducted in 130 adult patients with ALL between 16 and 60 years of age. After standard induction therapy, postinduction chemotherapy was given: three courses of high-dose cytarabine (2,000 mg/m2 every 12 hours for four doses) in combination with amsacrine (course one), mitoxantrone (course two), and etoposide (course three). CNS prophylaxis consisted of 10 injections of intrathecal methotrexate (IT MTX). Patients younger than 50 years with an HLA-identical sibling were eligible to receive allogeneic bone marrow transplantation (BMT).

RESULTS

Ninety-five patients (73%) achieved complete remission (CR); 82% were younger than 50 years and 41% were older than 50 years. Seventeen patients (13%) were resistant to chemotherapy, and 18 (14%) died during induction treatment. Only age and performance status were significantly associated with response (P<.001 and .03, respectively). Death during consolidation occurred in four patients. The estimated 5-year overall survival (OS) was 22% for the entire group and 26% for patients younger than 35 years. Disease-free survival (DFS) at 5 years was 28% +/- 6 for patients younger than 35 years, 25% +/- 9 for patients between 35 and 50 years, and 0% for patients older than 50 years. Increasing age (P<.01) and expression of CD34 (P<.01) were adverse factors. Only three patients (3%) developed an isolated CNS relapse.

CONCLUSION

Intensive consolidation including high-dose cytarabine not followed by maintenance therapy provides an outcome for adult patients with ALL that may be worse or even inferior compared with studies using long-term maintenance therapy. High-dose cytarabine in combination with IT MTX was effective for CNS prophylaxis.

摘要

目的

探讨成人急性淋巴细胞白血病（ALL）强化巩固化疗后不进行维持治疗的价值。

材料与方法

对130例年龄在16至60岁之间的成人ALL患者进行了一项多中心II期试验。在标准诱导治疗后，给予诱导后化疗：三个疗程的大剂量阿糖胞苷（每12小时2000mg/m²，共四剂）联合安吖啶（第一疗程）、米托蒽醌（第二疗程）和依托泊苷（第三疗程）。中枢神经系统预防包括鞘内注射甲氨蝶呤（IT MTX）10次。年龄小于50岁且有HLA匹配同胞的患者有资格接受异基因骨髓移植（BMT）。

结果

95例患者（73%）达到完全缓解（CR）；其中82%年龄小于50岁，41%年龄大于50岁。17例患者（13%）对化疗耐药，18例（14%）在诱导治疗期间死亡。仅年龄和体能状态与缓解显著相关（分别为P<0.001和0.03）。巩固治疗期间有4例患者死亡。整个组的估计5年总生存率（OS）为22%，35岁以下患者为26%。35岁以下患者5年无病生存率（DFS）为28%±6，35至50岁患者为25%±9，50岁以上患者为0%。年龄增加（P<0.01）和CD34表达（P<0.01）是不利因素。仅3例患者（3%）发生孤立性中枢神经系统复发。