Clearance of marrow infiltration after 1 week of therapy for childhood lymphoblastic leukaemia: Clinical importance and the effect of daunorubicin
Clearance of marrow infiltration after 1 week of therapy for childhood lymphoblastic leukaemia: Clinical importance and the effect of daunorubicin
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DOI：
10.1046/j.1365-2141.1997.1002914.x
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发表时间：
1997-06-01
影响因子：
6.5
通讯作者：
Hill, FGH
中科院分区：
文献类型：
--
作者：
Lilleyman, JS;Gibson, BES;Hill, FGH
在UKALL XI（一项针对儿童淋巴细胞白血病（ALL）的国家MRC试验）开始时，治疗包括在方案的前2天推注柔红霉素（DR）。由于担心长期心脏毒性，该治疗成分随后被撤回。在政策改变之前和之后，所有儿童在第一周结束时的骨髓状态都由中心审查评估，作为试验的一部分，以检查疾病清除率的临床重要性。这也提供了一个机会，观察DR的效果，在治疗的早期阶段的严重残留疾病。1419名儿童进行了研究：342名接受DR（“收件人”），1077没有。8d后，44%的受者骨髓原始细胞完全清除，而非受者仅13%（χ 2 = 158.2，P < 0.0001）。巨大残留病变（>80%原始细胞）比例的差异不太显著，但仍存在有利于DR接受者的差异（DR 9%，无DR 15%;卡方（2）= 7.7，P = 0.006）。疾病清除率与无病生存率相关的受体和非受体，但有没有显着差异的结果时，两组相互比较，无论是在无病或无复发survival.DR加速的速度从骨髓中的原始细胞的消失，但这种差异使无病生存是小的或不存在的。在将一种治疗与另一种治疗进行比较时，对给定治疗方案的相对反应速度似乎比绝对反应率更重要。
At the commencement of UKALL XI, a national MRC trial for childhood lymphoblastic leukaemia (ALL), the therapy included a bolus of daunorubicin (DR) on the first 2 d of the protocol. This component of treatment was subsequently withdrawn because of concern about longterm cardiotoxicity. All children both before and after this change of policy had their marrow status at the end of the first week assessed by central review as part of the trial to examine the clinical importance of the rate of disease clearance. This also afforded an opportunity to observe the effect of DR on gross residual disease at an early stage of therapy.1419 children were studied: 342 received DR ('recipients'), 1077 did not. 44% of the recipients completely cleared their marrow of blast cells after 8 d compared with 13% of the non-recipients (chi(2) = 158.2, P < 0.0001). The difference in the proportion with massive residual disease (>80% blasts) was less impressive but there was still a difference in favour of DR recipients (DR 9%, no DR 15%; chi(2) = 7.7, P = 0.006). The rate of disease clearance correlated with disease-free survival for both recipients and non-recipients, but there was no significant difference in outcome when comparing the two groups with each other, either in term of disease-free or relapse-free survival.DR accelerated the rate of blast cell disappearance from the marrow but the difference this made to disease free survival is small or non-existent. It appears to be the relative speed of response to a given therapeutic regimen that is prognostically important rather than the absolute rate of response when comparing one treatment with another.