Effects of cranial radiation in children with high risk T cell acute lymphoblastic leukemia: a Pediatric Oncology Group report.
Effects of cranial radiation in children with high risk T cell acute lymphoblastic leukemia: a Pediatric Oncology Group report.
复制标题
颅脑放射对高危 T 细胞急性淋巴细胞白血病儿童的影响：儿科肿瘤学小组报告。
DOI：
10.1038/sj.leu.2401693
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发表时间：
2000
期刊：
影响因子：
11.4
通讯作者：
Shuster,J
中科院分区：
文献类型：
--
作者：
Laver,JH;Barredo,JC;Amylon,M;Schwenn,M;Kurtzberg,J;Camitta,BM;Pullen,J;Link,MP;Borowitz,M;Ravindranath,Y;Murphy,SB;Shuster,J
当代化学疗法显著改善了T细胞系急性淋巴细胞白血病（T-ALL）患者的无事件存活率。与B-前体ALL不同，大多数研究者仍在使用颅放射（CRT），并且对于仅依赖于T-ALL的鞘内治疗犹豫不决。在这项研究中，我们评估了CRT对一组具有T细胞白血病高危特征的儿童的无事件生存和中枢神经系统（CNS）复发的影响。在一系列的六个连续研究（1987-1995）中，患者按照各自的方案非随机地分配他们的CNS预防。这些方案基于POG 8704，POG 8704依赖于诱导后的轮换药物组合（阿糖胞苷/环磷酰胺、替尼泊苷/阿糖胞苷和长春新碱/阿霉素/6-MP/泼尼松）。诸如高剂量阿糖胞苷、中等剂量甲氨蝶呤和添加G-CSF的修改被设计为提供更高的CNS药物水平（减少对CRT的需要）、消除茶碱毒素（减少继发性白血病的风险）和减少治疗相关的中性粒细胞减少（初步研究POG 9086、9295、9296、9297、9398）。包括在该分析中的所有患者符合POG高风险标准、WBC> 50000/mm 3和/或CNS白血病。未累及CNS的患者接受了16剂年龄调整的三联鞘内治疗（TIT=氢化可的松、MTX和阿糖胞苷），而CNS疾病患者在诱导和巩固期间接受了3剂TIT。接受CRT的患者接受2400 cGy（POG 8704）或1800 cGy（POG 9086和9295）治疗。CNS治疗包括144例患者的CRT，而其余78例患者根据原始方案设计不接受放射治疗。男性155例，女性57例，中位年龄8.2岁。CRT+和CRT−患者的中位WBC分别为186 000/mm 3和200 000/mm 3。诊断时CNS受累见于CRT+组的16%和CRT−组的23%。放疗组与非放疗组的完全持续缓解率（CCR）无显著差异（P= 0.46）。未照射组与照射组的3年无事件生存率分别为65%（se 6%）和63%（se 4%）。然而，未接受CRT的患者的3年CNS复发率显著更高; 18%（se 5%）vs照射组的7%（se 3%）（P= 0.012）。我们在非随机背景下的分析表明，CRT与无事件生存率无显著相关性，但忽略CRT对复发时CNS受累有不良影响。
contemporary chemotherapy has significantly improved event-free survival among patients with t cell-lineage acute lymphoblastic leukemia (t-all). unlike b-precursor all, most investigators are still using cranial radiation (crt) and are hesitant to rely solely on intrathecal therapy for t-all. in this study we assessed the effects of crt upon event-free survival and central nervous system (cns) relapses in a cohort of children with high risk features of t cell leukemia. in a series of six consecutive studies (1987–1995) patients were non-randomly assigned their cns prophylaxis per individual protocol. these protocols were based on pog 8704 which relied on rotating drug combinations (cytarabine/cyclophosphamide, teniposide/ara-c, and vincristine/doxorubicin/6-mp/prednisone) post-induction. modifications such as high-dose cytarabine, intermediate-dose methotrexate, and the addition of g-csf, were designed to give higher cns drug levels (decreasing the need for crt), to eliminate epidophyllotoxin (decreasing the risk of secondary leukemia), and to reduce therapy-related neutropenia (pilot studies pog 9086, 9295, 9296, 9297, 9398). all patients included in this analysis qualified for pog high risk criteria, wbc> 50 000/mm 3 and/or CNS leukemia. Patients without CNS involvement received 16 doses of age-adjusted triple intra-thecal therapy (TIT= hydrocortisone, MTX, and cytarabine) whereas patients with CNS disease received three more doses of TIT during induction and consolidation. Patients who received CRT were treated with 2400 cGy (POG 8704) or 1800 cGy (POG 9086 and 9295). CNS therapy included CRT in 144 patients while the remaining 78 patients received no radiation by original protocol design. There were 155 males and 57 females with a median age of 8.2 years. The median WBC for the CRT+ and CRT− patients were 186 000/mm 3 and 200 000/mm 3, respectively. CNS involvement at diagnosis was seen in 16% of the CRT+ and 23% of the CRT− groups. The complete continuous remission rate (CCR) was not significantly different for the irradiated vs non-irradiated groups (P= 0.46). The 3-year event-free survival was 65%(se 6%) and 63%(se 4%) for the non-irradiated vs the radiated group. However, the 3-year CNS relapse rate was significantly higher amongst patients who did not receive CRT; 18%(se 5%) vs 7%(se 3%) in the irradiated group (P= 0.012). Our analysis in a non-randomized setting, suggests that CRT did not significantly correlate with event-free survival but omitting it had an adverse effect on the CNS involvement at the time of relapse.