The use of intermediate dose methotrexate in increased risk childhood acute lymphoblastic leukemia a comparison of three versus six courses
The use of intermediate dose methotrexate in increased risk childhood acute lymphoblastic leukemia a comparison of three versus six courses
复制标题
使用中等剂量甲氨蝶呤治疗高危儿童急性淋巴细胞白血病，三个疗程与六个疗程的比较
作者：
D. Green;M. Brecher;L. Blumenson;M. Grossi;A. Freeman
在1974年1月至1978年11月期间，41<24 months or >例急性淋巴细胞白血病（ALL）患者连续接受了两种连续的治疗方案，其中使用了中等剂量甲氨蝶呤（IDM）。IDM用于中枢神经系统预防和全身强化。预计避免预防性颅骨照射将降低长期中枢神经系统后遗症的发生率。22名儿童和青少年入组第一项研究（IDM × 3），该研究采用3个疗程的IDM（500 mg/m2）和6剂鞘内（IT）甲氨蝶呤（MTX）。19名儿童和青少年入组第二项研究（IDM × 6），该研究采用6个疗程的IDM（3-500 mg/m2和3-1500 mg/m2）、6剂IT MTX和3剂额外的三联IT化疗（MTX、阿糖胞苷和氢化可的松或地塞米松）。IDM × 3组和IDM × 6组保持持续完全缓解的患者累积百分比分别为30%和57%。该差异具有统计学显著性（P = 0.046）。首次复发部位：骨髓（BM），7例; CNS，4例-使用IDM × 3; BM，2例; CNS，4例; BM + CNS，1例-使用IDM × 6。IDM × 3和IDM × 6的原发性CNS复发累积发生率分别为36.4%和29.9%。该差异无统计学显著性（P = 0.44）。使用IDM和三联IT化疗的强化治疗确实改善了持续完全缓解的持续时间，但没有降低高危患者原发性CNS复发的发生率。
Between January 1974 and November 1978, 41 consecutive increased risk (age <24 months or >120 months, or leukocyte count >30,000/mm3) patients with acute lymphoblastic leukemia (ALL) were entered on two consecutive treatment protocols which employed intermediate dose methotrexate (IDM). IDM was employed for central nervous system prophylaxis and systemic intensification. It was anticipated that the avoidance of prophylactic cranial irradiation would result in a lower incidence of long‐term central nervous system sequelae. Twenty‐two children and adolescents were entered on the first study (IDM × 3) which employed three courses of IDM (500 mg/m2) and six doses of intrathecal (IT) methotrexate (MTX). Nineteen children and adolescents were entered on the second study (IDM × 6) which employed six courses of IDM (3–500 mg/m2 and 3–1500 mg/m2), six doses of IT MTX and three additional doses of triple IT chemotherapy (MTX, cytosine arabinoside, and hydrocortisone or dexamethasone). The cumulative percentage of patients who remained in continuous complete remission was 30% for IDM × 3 and 57% for IDM × 6. This difference was statistically significant (P = 0.046). The site of first relapse was: bone marrow (BM), 7; CNS, 4—using IDM × 3; and BM, 2; CNS, 4; and BM + CNS, 1—using IDM × 6. The cumulative incidence of primary CNS relapse was 36.4% for IDM × 3 and 29.9% for IDM × 6. This difference was not statistically significant (P = 0.44). The use of more intensive therapy with IDM and triple IT chemotherapy did improve the duration of continuous, complete remission but did not decrease the incidence of primary CNS relapse in increased risk patients.