INTENSIVE RETREATMENT PROTOCOL FOR CHILDREN WITH AN ISOLATED CNS RELAPSE OF ACUTE LYMPHOBLASTIC-LEUKEMIA
INTENSIVE RETREATMENT PROTOCOL FOR CHILDREN WITH AN ISOLATED CNS RELAPSE OF ACUTE LYMPHOBLASTIC-LEUKEMIA
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DOI：
10.1200/jco.1995.13.2.333
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发表时间：
1995-02-01
影响因子：
45.3
通讯作者：
PUI, CH
中科院分区：
文献类型：
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作者：
RIBEIRO, RC;RIVERA, GK;PUI, CH
目的：评估急性淋巴细胞白血病 (ALL) 首次缓解期间孤立性 CNS 复发强化治疗的儿童的挽救率和长期并发症。 患者和方法：12 名男孩和 8 名女孩，中位年龄 4 岁诊断，中位年龄 7 岁出现 CNS 复发。 5 人就诊时患有中枢神经系统白血病，5 人在复发前完成了治疗。首次完全缓解持续时间中位数为 22.5 个月。 10 名患者接受了颅脑照射加鞘内 (IT) 治疗，其余患者接受了高剂量静脉注射和/或 IT 甲氨蝶呤 (MTX) 作为中枢神经系统定向治疗。恢复治疗包括五种药物强化再诱导方案，然后是四种轮换药物对的继续治疗。每周进行三重 IT 治疗，持续 4 至 5 周，然后每 6 周进行一次，直至进行颅脊髓放射（颅骨，24 Gy；脊柱，15 Gy；两个部位，每次 1.5 Gy）。 结果：所有 20 名儿童均获得第二次完全缓解。 5 年无病生存率（平均值 +/- SE）估计为 70% +/- 11%。 13 名患者在 71+ 至 126+ 个月（中位数为 104+）时仍处于缓解状态，接受测试的 13 名患者中有 10 名智商得分正常。四名患者出现第二次复发（一名中枢神经系统患者，三名非中枢神经系统患者），三名患者出现其他恶性肿瘤。先前的颅脑照射与随后的失败有关；与其他 10 名患者相比，之前接受过放疗的 10 名患者中只有 3 名仍处于第二次缓解期。结论：这种强化恢复疗法对于患有 ALL 孤立性 CNS 复发的儿童有效且耐受性良好，尤其是那些先前未接受过颅脑照射的儿童。大多数患者没有明显的神经心理障碍。
Purpose: To assess the salvage rate and long-term complications among children treated with an intensive regimen for isolated CNS relapse during first remission of acute lymphoblastic leukemia (ALL).Patients and Methods: Twelve boys and eight girls, diagnosed at a median age of 4 years, had CNS relapse at a: median age of 7 years. Five had CNS leukemia at presentation, while five completed treatment before relapse. First complete remission lasted a median of 22.5 months. Ten patients had received cranial irradiation plus intrathecal (IT) therapy, and the remainder had received high-dose intravenous and/or IT methotrexate (MTX) as CNS-directed treatment. Retrieval therapy consisted of a five-agent intensive reinduction regimen followed by continuation therapy with four rotating drug pairs. Triple-IT therapy was administered weekly for 4 to 5 weeks, then every 6 weeks until craniospinal radiation (cranium, 24 Gy; spine, 15 Gy; both sites, 1.5 Gy per fraction) was administered.Results: All 20 children achieved a second complete remission. The 5-year estimate of disease-free survival (mean +/- SE) was 70% +/- 11%. Thirteen patients remain in remission at 71 + to 126 + months (median, 104 +), and 10 of 13 patients tested have normal IQ scores. Four patients have had a second relapse (one CNS and three non-CNS), and three have developed other malignancies. Prior cranial irradiation was associated with subsequent failure; only three of 10 patients who previously received radiotherapy, compared with all of the other 10 patients, remained in second remission.Conclusion: This intensive retrieval therapy is effective and well tolerated by children with an isolated CNS relapse of ALL, especially those who have not received prior cranial irradiation. Most patients have no significant neuropsychologic impairment.