“Total therapy” studies of acute lymphocytic leukemia in children. Current results and prospects for cure
“Total therapy” studies of acute lymphocytic leukemia in children. Current results and prospects for cure
复制标题
儿童急性淋巴细胞白血病的“整体治疗”研究当前结果和治愈前景。
作者：
J. Simone;R. Aur;H. Hustu;D. Pinkel
“全面治疗”研究的最终目标是为儿童急性淋巴细胞性白血病建立一个显著的治愈率。这些研究的主要特点包括最大耐受性联合化疗和“预防性”中枢神经系统(CNS)照射。在前三项研究中，获得了17%的7年无白血病缓解率。完全缓解的患者数量在2到3年前呈指数级下降，但此后稳定下来。完全缓解时间是长期无白血病缓解的最早和最准确的指标。在研究V中，接受了更积极的中枢神经系统治疗，超过一半的患者持续完全缓解了3年半至4年。在随后的研究中也出现了类似的结果，这些研究也采用了积极的“预防性”中枢神经系统疗法。在“完全治疗”研究中，42名患者在完全缓解2年或更长时间后停止治疗，其中9人复发。9名患者中有6名没有接受过“预防性”中枢神经系统照射。如果这些研究中目前的趋势继续下去，我们预计长期无白血病缓解率将达到50%。因此，以目前可用的治疗方式来看，治愈的前景似乎是光明的。
The ultimate goal of “total therapy” studies has been to establish a significant cure rate for childhood acute lymphocytic leukemia. The principle features of these studies have included administration of maximum tolerated combination chemotherapy and “prophylactic” central nervous system (CNS) irradiation. In the first three studies, a 17% 7‐year leukemia‐free remission rate was attained. The number of patients in complete remission decreased exponentially until 2 to 3 years, but stabilized thereafter. Complete remission duration was the earliest and most accurate indicator of long‐term leukemia‐free remission. In Study V, more aggressive CNS therapy was given and over half the patients have been in continuous complete remission for 3 1/2 to 4 years. Similar results are emerging in subsequent studies which also employ aggressive “prophylactic” CNS therapy. Therapy was stopped after 2 or more years of complete remission in 42 patients in “total therapy” studies, and nine have relapsed. Six of the nine had not received “prophylactic” CNS irradiation. If current trends in these studies continue, we can expect a 50% long‐term leukemia‐free remission rate. Thus, with currently available modalities of therapy, the prospects for cure appear bright.