Improved outcome for children with acute lymphoblastic leukemia: results of Dana-Farber Consortium Protocol 91-01
Improved outcome for children with acute lymphoblastic leukemia: results of Dana-Farber Consortium Protocol 91-01
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DOI：
10.1182/blood.v97.5.1211
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发表时间：
2001-03-01
期刊：
影响因子：
20.3
通讯作者：
Sallan, SE
中科院分区：
文献类型：
--
作者：
Silverman, LB;Gelber, RD;Sallan, SE
Dana-Farber癌症研究所（DFCI）急性淋巴细胞白血病（ALL）联盟方案91-01旨在改善新诊断ALL儿童的结局，同时将毒性降至最低。与先前方案相比，缓解后治疗通过地塞米松替代泼尼松并将门冬酰胺酶强化时间从20周延长至30周来加强。1991年至1995年，377例患者（年龄，0-18岁）入组; 137例患者被认为是标准风险（SR），240例患者被认为是高风险（HR），在5.0年中位随访后，所有患者的估计5年无事件生存率（EFS）+/- SE为83% +/-2%，这上级1981年至1991年期间进行的先前DFCI ALL联盟协议（P = .03），基于风险组的5年EFS无显著差异（SR为87% +/- 3%，HR为81% +/- 3%，P = 0.24），诊断时的年龄是一个具有统计学意义的预后因素（P = 0.03），在婴儿和9岁或以上儿童中观察到较差的结局，耐受25周或更短时间门冬酰胺酶治疗的患者的结局显著差于接受至少26周门冬酰胺酶治疗的患者（P <0.01，单变量和多变量）。年龄较大的儿童（至少9岁）更可能耐受25周或更少的天冬酰胺酶（P <0.01），方案91-01治疗显著改善了ALL儿童的结局，可能是由于延长了天冬酰胺酶强化和/或使用地塞米松。年龄较大的儿童预后较差，部分原因可能是对强化治疗的不耐受性增加。（血。2001;97：1211-1218）（C）2001年由美国血液学会。
The Dana-Farber Cancer Institute (DFCI) acute lymphoblastic leukemia (ALL) Consortium Protocol 91-01 was designed to improve the outcome of children with newly diagnosed ALL while minimizing toxicity, Compared with prior protocols, past-remission therapy was intensified by substituting dexamethasone for prednisone and prolonging the asparaginase intensification from 20 to 30 weeks, Between 1991 and 1995, 377 patients (age, 0-18 years) were enrolled; 137 patients were considered standard risk (SR), and 240 patients were high risk (HR), Following a 5.0-year median follow-up, the estimated 5-year event-free survival (EFS) +/- SE for all patients was 83% +/- 2%, which is superior to prior DFCI ALL Consortium protocols conducted between 1981 and 1991 (P = .03), There was no significant difference in 5-year EFS based upon risk group (87% +/- 3% for SR and 81% +/- 3% for HR, P = .24), Age at diagnosis was a statistically significant prognostic factor (P = .03), with inferior outcomes observed in infants and children 9 years or older, Patients who tolerated 25 or fewer weeks of asparaginase had a significantly worse outcome than those who received at least 26 weeks of asparaginase (P < .01, both univariate and multivariate). Older children (at least 9 years of age) were significantly more likely to have tolerated 25 or fewer weeks of asparaginase (P < .01), Treatment on Protocol 91-01 significantly improved the outcome of children with ALL, perhaps due to the prolonged asparaginase intensification and/or the use of dexamethasone. The inferior outcome of older children may be due, in part, to increased intolerance of intensive therapy. (Blood. 2001;97:1211-1218) (C) 2001 by The American Society of Hematology.