Intensified and shortened cyclical chemotherapy for adult acute lymphoblastic leukemia
Intensified and shortened cyclical chemotherapy for adult acute lymphoblastic leukemia
复制标题
DOI：
10.1200/jco.2002.07.116
复制
发表时间：
2002-05-15
影响因子：
45.3
通讯作者：
Navarro, W
中科院分区：
文献类型：
--
作者：
Linker, C;Damon, L;Navarro, W
目的：评价强化和缩短周期化疗（方案8707）治疗成人急性淋巴细胞白血病（ALL）的疗效和毒性。患者和方法：既往未治疗的成人：960岁ALL患者接受四药诱导化疗方案治疗。随后是高剂量阿糖胞苷/依托泊苷的周期性缓解后治疗；大剂量甲氨蝶呤和6 -巯基嘌呤;柔红霉素，长春新碱，强的松和天冬酰胺酶。维持化疗持续口服甲氨蝶呤和6-巯基嘌呤30个月。除了上述的全身化疗外，还给予鞘内甲氨蝶呤预防中枢神经系统。结果：84例患者中78例（93%）达到完全缓解。中位随访5.6年，所有缓解患者的5年无事件生存率（EFS）为52%。具有高危特征的患者，包括不良细胞遗传学、第一周期化疗未能达到缓解、白细胞计数超过100,000/muL的b前体疾病，除非取消移植研究，否则均复发。对于没有这些高危特征的患者，5年EFS为60%。与我们之前的治疗方案相比，标准风险b前体疾病患者的结果似乎有所改善（5年EFS， 66% vs 34%; P = 0.01）。结论：强化和缩短化疗可改善无高危特征的ALL伴b前体疾病患者的预后。该方案的进一步试验是有必要的。2002年由美国临床肿瘤学会出版。
Purpose: To assess the efficacy and toxicity of a new treatment program of intensified and shortened cyclical chemotherapy (protocol 8707) in adults with acute lymphoblastic leukemia (ALL).Patients and Methods: Previously untreated adults :9 60 years old with ALL were treated with a four-agent induction chemotherapy regimen. This was followed by cyclical postremission therapy with high-dose cytarabine/etoposide; high-dose methotrexate/6-mercaptopurine; and daunorubicin, vincristine, prednisone, and asparaginase. Maintenance chemotherapy with oral methotrexate and 6-mercaptopurine was continued for 30 months. CNS prophylaxis was given with intrathecal methotrexate in addition to the systemic chemotherapy indicated above.Results: Seventy-eight of 84 patients (93%) achieved complete remission. With a median follow-up of 5.6 years, 5-year event-free survival (EFS) of all remission patients is 52%. Patients with high-risk features including adverse cytogenetics, failure to achieve remission with the first cycle of chemotherapy, and B-precursor disease with WBC counts more than 100,000/muL all relapsed unless taken off study for transplantation. For patients without these high-risk features, 5-year EFS was 60%. Compared with our previous treatment regimen, results appear to be improved for patients with standard-risk B-precursor disease (5-year EFS, 66% v 34%; P = .01).Conclusion: Intensified and shortened chemotherapy may improve the outcome for patients with ALL with B-precursor disease lacking high-risk features. Further trials of this regimen are warranted.,, 2002 by American Society of Clinical Oncology.