Improving outcome through two decades in childhood ALL in the Nordic countries:: the impact of high-dose methotrexate in the reduction of CNS irradiation
Improving outcome through two decades in childhood ALL in the Nordic countries:: the impact of high-dose methotrexate in the reduction of CNS irradiation
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DOI：
10.1038/sj.leu.2401961
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发表时间：
2000-12-01
期刊：
影响因子：
11.4
通讯作者：
Saarinen-Pihkala, UM
中科院分区：
文献类型：
--
作者：
Gustafsson, G;Schmiegelow, K;Saarinen-Pihkala, UM
在这份来自五个北欧国家（丹麦、芬兰、冰岛、挪威和瑞典）的基于人群的材料中，从1981年7月至1998年6月，2860名15岁以下儿童被诊断为急性淋巴细胞白血病（ALL）。年发病率为3.9/10万儿童，在整个研究期间保持稳定。1992年，通过连续加强多种药物化疗，包括大剂量甲氨蝶呤脉冲治疗和避免对大多数儿童进行颅部照射，完成了从区域或国家方案到北欧所有危险群体共同治疗方案的发展。5年的总体无事件生存率（EFS）从20世纪80年代早期的56.5 +/- 1.7%增加到20世纪90年代的77.6 +/- 1.4%。主要改善见于非高危白血病儿童。在高危患者中，进展是中等的，特别是在诊断时WBC高（大于或等于100 × 10（9）/l）的儿童中。在上一个时期，（1992年1月至1998年6月），只有10%的患者在第一次缓解时接受了颅骨照射，而90%的患者接受了大剂量甲氨蝶呤脉冲治疗（5-8 g/m2）单独或与高剂量阿糖胞苷联合使用（总剂量12 g/m2）加多次鞘内注射甲氨蝶呤作为CNS靶向治疗，不会导致CNS复发的累积发生率增加。
In this population-based material from the five Nordic countries (Denmark, Finland, Iceland, Norway and Sweden), 2860 children below 15 years of age were diagnosed with acute lymphoblastic leukemia (ALL) from July 1981 to June 1998. The annual incidence was 3.9/100000 children and was stable throughout the study period. The development from regional or national protocols to common Nordic treatment protocols for all risk groups was completed in 1992 through a successive intensification with multidrug chemotherapy, including pulses of methotrexate in high doses and avoidance of cranial irradiation in most children. The overall event-free survival (EFS) at 5 years has increased from 56.5 +/- 1.7% in the early 1980s to 77.6 +/- 1.4% during the 1990s. The main improvements were seen in children with non-high risk leukemia. In high-risk patients, progress has been moderate, especially in children with high WBC (greater than or equal to 100 x 10(9)/l) at diagnosis. During the last time period (January 1992-June 1998), only 10% of the patients have received cranial irradiation in first remission, while 90% of the patients have received pulses of high dose methotrexate (5-8 g/m(2)) isolated or combined with high-dose cytosine arabinoside (total dose 12 g/m(2)) plus multiple intrathecal injections of methotrexate as CNS-targeted treatment, not translating into increased cumulative incidence of CNS relapse.