Long-term survivors of acute lymphoblastic leukemia--risk of relapse after cessation of therapy.
Long-term survivors of acute lymphoblastic leukemia--risk of relapse after cessation of therapy.
复制标题
急性淋巴细胞白血病的长期幸存者——停止治疗后复发的风险。
DOI：
--
复制
发表时间：
1981
期刊：
影响因子：
--
通讯作者：
J. Lusher
中科院分区：
文献类型：
--
作者：
Y. Ravindranath;D. Soorya;G. Schultz;J. Lusher
分析了64例急性淋巴细胞白血病（ALL）长期生存者（无病生存期5年或更长）停止治疗（COT）的结果，以确定治疗后复发的发生率。37例患者接受间歇性中枢神经系统（CNS）预防治疗。诊断后的总随访时间为5.75 - 27.75年。中位停药时间为3年（范围：8个月至26年）。86%（55/64）的患者在最初的缓解期继续治疗。8例患者复发，1例患者复发时有形态学不同的白血病。所有复发发生在诊断后5至8年之间，该期间的累积复发率为0.14。接受CNS预防治疗的患者（0.08）与未接受CNS预防治疗的患者（0.19）的复发率无显著差异。男孩复发率（0.24）与女孩复发率（0.04）的差异具有统计学意义（P = 0.04）。孤立睾丸复发（ITR）是没有看到任何的34名男孩。本研究证实了其他人早期的观察结果，即在缓解期超过7至8年的ALL患者中复发是罕见的。在整个维持化疗期间接受间歇性CNS预防性治疗的所有患者，与接受高剂量初始颅照射和鞘内甲氨蝶呤治疗的患者相比，似乎没有更大的复发风险。对于男孩和男性，治疗持续时间较长和使用重复再诱导方案维持治疗似乎与停止治疗后ITR风险降低相关。在白血病的长期存活者中，似乎有一个很小但确定的“第二次”白血病风险。
The results of cessation of therapy (COT) in 64 long-term survivors (disease-free survival of five years or more) of acute lymphoblastic leukemia (ALL) were analyzed to determine the incidence of relapse off therapy. Thirty-seven of the patients had intermittent central nervous system (CNS) prophylaxis. Total follow-up from diagnosis varied from 5.75 to 27.75 years. The median time off therapy was three years (range, 8 months to 26 years). Eighty-six percent (55/64) of the patients continue in their initial remission. Eight patients had relapse, and one patient had a morphologically different leukemia at recurrence. All the relapses occurred between five to eight years from diagnosis and the cumulative rate of relapse for the period was 0.14. There was no significant difference in the rate of relapse for those receiving CNS prophylaxis (0.08) versus those not receiving CNS prophylaxis (0.19). The difference in the relapse rates for boys (0.24) versus girls (0.04) was statistically significant (P = 0.04). Isolated testicular relapse (ITR) was not seen in any of the 34 boys. The present study confirms the earlier observations by others that relapse is uncommon in ALL patients remaining in remission longer than seven to eight years. ALL patients treated with intermittent CNS prophylaxis administered throughout the period of maintenance chemotherapy appear to be at no greater risk for relapse off therapy than those treated with high-dose initial cranial irradiation and intrathecal methotrexate. The longer duration of therapy and the use of a repetitive reinduction regimen for maintenance seem to be associated with a decreased risk of ITR after discontinuation of therapy for boys and men. There appears to be a small but definite risk of "second" leukemia in the long-term survivors of leukemia.