Evidence of a treatment dose response in acute nonlymphocytic leukemias which occur after therapy of non-Hodgkin's lymphoma.
Evidence of a treatment dose response in acute nonlymphocytic leukemias which occur after therapy of non-Hodgkin's lymphoma.
复制标题
非霍奇金淋巴瘤治疗后发生的急性非淋巴细胞白血病的治疗剂量反应的证据。
作者：
M. Greene;R. Young;J. M. Merrill;V. Devita
我们评估了在国家癌症研究所接受治疗的517例非霍奇金淋巴瘤(NHL)患者中继发癌症的发生情况。观察到9例急性非淋巴细胞白血病(ANL)，而预期病例为0.08例(观察病例与预期病例的比率为105；95%可信区间为48；199)。ANL的超额风险为每年每1000名患者4.1例；10年ANL的累积风险为7.9+/-3.2%(S.E.)。NHL队列中的一项病例对照研究显示，同时接受放疗和化疗的患者比接受单一治疗的患者患ANL的风险更高(相对风险为6.0；p<0.05)，特别是当治疗包括全身或半身放射时。骨髓累积辐射剂量与ANL风险呈正相关，与化疗持续时间无关。化疗剂量与ANL风险之间存在类似的相关性，但无法用现有数据加以证实。ANL风险和惰性NHL组织亚型之间的明显关联是由于这些患者反复接受大量潜在的白血病治疗。只有一例ANL发生在NHL患者中，他们的初始治疗产生了持久的完全缓解。我们的数据与白血病发生的多步骤模型相一致，也强调了治疗NHL的治疗方案的必要性，该方案可以最大限度地减少最佳患者管理所需的治疗持续时间和数量。
We evaluated the occurrence of second cancers among 517 patients with non-Hodgkin's lymphoma (NHL) treated at the National Cancer Institute. Nine cases of acute nonlymphocytic leukemia (ANL) were observed compared to 0.08 cases expected (ratio of observed to expected cases, 105; 95% confidence limits, 48; 199). The excess risk of ANL was 4.1 cases per 1000 patients per year; the cumulative risk of ANL at 10 years was 7.9 +/- 3.2% (S.E.). A case-control study within the NHL cohort revealed that patients treated with both radiation and chemotherapy were at greater risk of ANL than were patients who received single-modality therapy (relative risk, 6.0; p less than 0.05), especially if the therapy included total-body or hemibody radiation. A positive correlation between cumulative radiation dose to the bone marrow and risk of ANL was demonstrated, independent of chemotherapy duration. A similar correlation between chemotherapy dose and risk of ANL was suggested but could not be proven with the available data. An apparent association between ANL risk and indolent NHL histological subtypes was due to the significantly larger amounts of potentially leukemogenic therapy to which these patients were repeatedly exposed. Only one case of ANL occurred among NHL patients whose initial therapy produced a durable complete remission. Our data are compatible with a multistep model of leukemogenesis and also underscore the need for curative NHL treatment regimens which minimize the duration and quantity of therapy required for optimum patient management.