Marked improvements in outcome with chemotherapy alone in paediatric acute myeloid leukaemia: results of the United Kingdom Medical Research Council's 10th AML Trial
Marked improvements in outcome with chemotherapy alone in paediatric acute myeloid leukaemia: results of the United Kingdom Medical Research Council's 10th AML Trial
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DOI：
10.1046/j.1365-2141.1998.00677.x
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发表时间：
1998-04-01
影响因子：
6.5
通讯作者：
Gray, RG
中科院分区：
文献类型：
--
作者：
Stevens, RF;Hann, IM;Gray, RG
1988年5月至1995年3月期间，359名符合条件的急性髓系白血病（AML）儿童参加了MRC AML 10试验。患者接受了四个疗程的强化诱导和巩固化疗，随后进行或不进行自体（A-BMT）或同种异体（allo-BMT）骨髓移植。对诱导中的硫鸟嘌呤与依托泊苷以及 A-BMT 与未诱导的情况进行了随机比较。建议对有 HLA 匹配兄弟姐妹的患者进行同种异体 BMT，并通过供体与无供体比较进行评估。完全缓解率为92%。在首次缓解期，巩固化疗期间有 20 例死亡，BMT 后有 11 例死亡（8/61 异基因 BMT、1/60 A-BMT 和 2/4 匹配的无关供体移植）。复发率低，从第一年的26%下降到第四年的2%。长期结果非常出色，入组后 7 年生存率为 56%，无事件生存率为 48%。硫鸟嘌呤和依托泊苷之间没有显着差异，而 A-BMT 和异基因 BMT 都降低了复发风险，但没有产生显着的生存获益。看来：超过一半进入 AML 10 的儿童已治愈，这一结果与其他报道的系列相比毫不逊色。我们的结论是，四个疗程的强化化疗是治疗儿童AML的有效方法，它避免了BMT的急性毒性和长期副作用，也避免了长期维持治疗或颅脑照射的需要。
359 eligible children with acute myeloid leukaemia (AML) entered the MRC AML 10 trial between May 1988 and March 1995. Patients received four courses of intensive induction and consolidation chemotherapy, with or without subsequent autologous (A-BMT) or allogeneic (allo-BMT) bone marrow transplant. There were randomized comparisons of thioguanine versus etoposide in induction and of A-BMT versus not. Allo-BMT was recommended for patients with a HLA-matched sibling and was evaluated by donor versus no donor comparison. The complete remission rate was 92%. In first remission there were 20 deaths during consolidation chemotherapy and 11 after BMT (8/61 allo-BMTs. 1/60 A-BMTs and 2/4 matched unrelated donor transplants). The relapse rate was low, decreasing from 26% in the first year to 2% in the fourth. Long-term outcome was excellent with survival at 7 years from entry of 56% and event-free survival of 48%. There were no significant differences between thioguanine and etoposide, whereas both A-BMT and allo-BMT reduced relapse risk but did not produce a significant survival benefit. It appears that: over half the children entered into AML 10 are cured, a result which compares favourably with other reported series. We conclude that four courses of intensive chemotherapy are an effective approach to the treatment of paediatric AML, which avoids the acute toxicity and long-term side-effects of BMT and also avoids the need for prolonged maintenance therapy or cranial irradiation.