Long-term results of the Italian Association of Pediatric Hematology and Oncology (AIEOP) acute lymphoblastic leukemia studies, 1982-1995
Long-term results of the Italian Association of Pediatric Hematology and Oncology (AIEOP) acute lymphoblastic leukemia studies, 1982-1995
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DOI：
10.1038/sj.leu.2401963
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发表时间：
2000-12-01
期刊：
影响因子：
11.4
通讯作者：
Masera, G
中科院分区：
文献类型：
--
作者：
Conter, V;Arico, M;Masera, G
意大利第一个针对儿童急性淋巴细胞白血病 (ALL) 的多中心治疗方法始于 20 世纪 70 年代初，当时意大利 Ematologia ed Oncologia Pediatrica (AIEOP) 成立。从那时起，AIEOP 开始在全国范围内实施化疗方案。这里报告了三个不同时期（1982-1986、1987-1990、1991-1995）获得的结果。治疗方案的特点是逐渐加强全身治疗，并逐步用长期鞘内治疗代替颅内照射作为中枢神经系统（CNS）预防性治疗。在第三阶段，仅对复发风险高或诊断时中枢神经系统受累的患者（约占总人群的 15%）进行颅脑放射治疗 (CRT)。在此考虑的三个时期内，治疗结果逐渐改善，孤立的中枢神经系统复发率稳步降低。 AIEOP 经验表明，非高危患者可以安全地省略 CRT，除非他们是诊断时 WBC 计数大于或等于 100 000/mm(3) 的 T-ALL 患者，并且强化治疗可以改善总体结果，减少 NCI 预后标准的影响。多年来，AIEOP 还不断促进国际层面的积极合作。在与 BFM 小组合作进行的正在进行的 AIEOP ALL 2000 研究中，根据易位 t(9;22) 和 t(4;11) 的存在以及治疗反应（初始类固醇治疗或诱导）或微小残留病对患者进行分层。这种合作将允许充分招募患者，以便在根据微小残留病发现对患者进行分层的研究中回答相关的随机问题。
The first multicentric approach to childhood acute lymphoblastic leukemia (ALL) treatment in Italy started in the early 1970s when the Associazione Italiana di Ematologia ed Oncologia Pediatrica (AIEOP) was founded. Since then the AIEOP has conducted nationwide chemotherapy protocols. Results obtained in three different periods (1982-1986, 1987-1990, 1991-1995) are reported here. Treatment schedules have been characterized by a progressive intensification of systemic therapy and by a progressive substitution of protracted intrathecal therapy for cranial irradiation as central nervous system (CNS) preventive therapy. In the third period cranial radiotherapy (CRT) has been administered only to patients at high risk of relapse or with CNS involvement at diagnosis (about 15% of the overall population). A progressive improvement of therapeutic results, with a steady reduction of isolated CNS relapse rates have been obtained in the three periods considered here. The AIEOP experience shows that CRT can be safely omitted in non-high risk patients, unless they are T-ALL patients with WBC count at the diagnosis greater than or equal to 100 000/mm(3), and that intensification of treatment allows the improvement of overall results with a reduction of the impact of NCI prognostic criteria. Over the years, AIEOP has also continued to foster active cooperation at an international level. In the ongoing AIEOP ALL 2000 study, conducted in cooperation with the BFM group, patients are stratified according to the presence of translocations t(9;22) and t(4;11) and to treatment response (either initial steroid therapy or induction) or minimal residual disease). This cooperation will allow an adequate recruitment of patients to answer relevant randomized questions in the context of a study in which patients are stratified according to minimal residual disease findings.