4-AGENT INDUCTION AND INTENSIVE ASPARAGINASE THERAPY FOR TREATMENT OF CHILDHOOD ACUTE LYMPHOBLASTIC-LEUKEMIA
4-AGENT INDUCTION AND INTENSIVE ASPARAGINASE THERAPY FOR TREATMENT OF CHILDHOOD ACUTE LYMPHOBLASTIC-LEUKEMIA
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DOI：
10.1056/nejm198609113151101
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发表时间：
1986-09-11
影响因子：
158.5
通讯作者：
SALLAN, SE
中科院分区：
文献类型：
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作者：
CLAVELL, LA;GELBER, RD;SALLAN, SE
我们前瞻性地将289例连续急性淋巴细胞白血病患儿根据诊断时是否存在某些危险因素分为两组。高风险患者（占总数的62%）有以下一个或多个风险因素：年龄小于2岁或大于9岁，白细胞计数为每立方毫米20，000或更多，T细胞免疫标记物的存在，纵隔肿块的放射学证据以及中枢神经系统受累。标准风险组和高风险组的患者均接受了两年的治疗，接受强化缓解诱导治疗，中枢神经系统预防，每周给予高剂量天冬酰胺酶和多种药物持续治疗（高风险组包括多柔比星和更大剂量的泼尼松）。在中位随访35个月时，平均（. ±.标准风险组和高风险组患者的4年无事件生存率为86 ± 0.9%。4%和71.+-. 4%（P = 0.003），总的无事件生存率为77. ±.百分之三。在高危组中，诊断时的白细胞计数和患者的性别不是重要的预后指标，但诊断时年龄低于12个月与预后非常差相关。与以前的方法相比，使用四种药物诱导和强化门冬酰胺酶治疗的治疗方案提高了急性淋巴细胞白血病儿童的无事件生存率。
We prospectively assigned 289 consecutive children with acute lymphoblastic leukemia to receive one of two treatment programs on the basis of the presence or absence of certain risk factors at the time of diagnosis. Patients at high risk (62 percent of the total) had one or more of the following risk factors: age below two or above nine years, a white-cell count of 20,000 per cubic millimeter or more, the presence of T-cell immunologic markers, radiologic evidence of a mediastinal mass, and involvement of the central nervous system. Patients in both the standard-risk and high-risk groups were treated for two years, receiving intensive remission-induction therapy, central nervous system prophylaxis, weekly administration of high-dose asparaginase, and multiple-drug continuation therapy (which in the high-risk group included doxorubicin and a larger dose of prednisone). At a median follow-up of 35 months, the mean (.+-.SE) event-free survival rates at four years among the patients in the standard-risk and high-risk groups were 86.+-.4 percent and 71.+-.4 percent, respectively (P = 0.003), for a total event-free survival of 77.+-.3 percent. Within the high-risk group, the white-cell count at diagnosis and the sex of the patient were not significant prognostic indicators, but age below 12 months at diagnosis was associated with a very poor outcome. As compared with previous methods, this treatment program using four-drug induction and intensive asparaginase therapy has resulted in improved event-free survival in children with acute lymphoblastic leukemia.