INCREASED RISK OF SECONDARY ACUTE NONLYMPHOCYTIC LEUKEMIA AFTER EXTENDED-FIELD RADIATION-THERAPY COMBINED WITH MOPP CHEMOTHERAPY FOR HODGKINS-DISEASE
INCREASED RISK OF SECONDARY ACUTE NONLYMPHOCYTIC LEUKEMIA AFTER EXTENDED-FIELD RADIATION-THERAPY COMBINED WITH MOPP CHEMOTHERAPY FOR HODGKINS-DISEASE
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DOI：
10.1200/jco.1990.8.7.1148
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发表时间：
1990-07-01
影响因子：
45.3
通讯作者：
FLANDRIN, G
中科院分区：
文献类型：
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作者：
ANDRIEU, JM;IFRAH, N;FLANDRIN, G
本研究的目的是评价何杰金S病(HD)一次联合治疗后，不同的甲基强的松龙、长春新碱、甲基强的松龙和长春新碱联合化疗周期数和照射范围对继发性急性非淋巴细胞白血病风险的影响。自1972年4月至1980年5月，对462例临床分期(CS)为I、II、III的HD患者进行了3~6个周期的MOPP加40Gy隔膜上和(或)下照射。441例患者获得完全缓解(CR)。截至1988年1月，237例患者在首次CR后获得至少10年的随访。10例患者在完全缓解34个月至123个月期间发生SANLL。15年期SANLL风险为3.5%。+-。2.7%。对所有初始和治疗协变量(性别、年龄、组织学、脾切除、MOPP化疗和照射范围)进行的COX‘S逐步回归分析显示，SANLL风险的唯一显著解释变量是照射范围(P<；.002)。采用LOG-RANK检验，SANLL的风险范围从单纯横隔上照射的2.2%到次全(STNI)或全结节照射(TNI)的9.1%(P<；.001)。提示HD不宜采用大剂量延长照射联合MOPP方案治疗。
The purpose of this study was to evaluate the influence of the number of mechlorethamine, vincristine, procarbazine, and prednisolone (MOPP) cycles and the extent of irradiation on the risk of secondary acute nonlymphocytic leukemia (SANLL) after a single combined treatment for Hodgkin''s disease (HD). Between April 1972 and May 1980, 462 patients with HD clinical stage (CS) I, II, and III were prospectively treated with three or six cycles of MOPP and supra- and/or infradiaphragmatic irradiation (40 Gy). Four hundred forty-one patients achieved complete remission (CR). By January 1988, 237 patients had been followed-up in first CR for at least 10 years. Ten patients developed SANLL between the 34th and 123rd month of CR. The 15-year SANLL risk is 3.5% .+-. 2.7%. Cox''s stepwise regression analysis performed with all initial and treatment covariates (sex, age, histology, splenectomy, MOPP chemotherapy, and irradiation extent) showed that the only significant explanatory variable of SANLL risk was the irradiation extent (P < .002). Using the log-rank test, SANLL risk ranged from 2.2% for supradiaphragmatic irradiation alone to 9.1% for subtotal (STNI) or total nodal irradiation (TNI) (P < .001). These results strongly suggested that extended high-dose irradiation and MOPP chemotherapy should not be combined for the treatment of HD.