THE IMPORTANCE OF AN ISOLATED CENTRAL NERVOUS-SYSTEM RELAPSE IN CHILDREN WITH ACUTE LYMPHOBLASTIC-LEUKEMIA
THE IMPORTANCE OF AN ISOLATED CENTRAL NERVOUS-SYSTEM RELAPSE IN CHILDREN WITH ACUTE LYMPHOBLASTIC-LEUKEMIA
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DOI：
10.1200/jco.1985.3.6.776
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发表时间：
1985-01-01
影响因子：
45.3
通讯作者：
SIMONE, JV
中科院分区：
文献类型：
--
作者：
GEORGE, SL;OCHS, JJ;SIMONE, JV
对 1967 年中期至 1979 年中期入住圣犹达儿童研究医院（孟菲斯）的 839 名急性淋巴细胞白血病 (ALL) 儿童的初始孤立性脑膜复发对治疗结果的影响进行了评估。这些患者参加了一系列 5 项临床试验（总体治疗研究 V-IX），每项试验旨在测试 ALL 治疗的 1 种或多种修改。比较了两组：699 名接受 CNS 预防的儿童（2,400 拉德颅脊髓照射或 2400 拉德颅脑照射加鞘内甲氨蝶呤）与 56 名未接受治疗的儿童。通过时间依赖性协变量模型和匹配技术，与没有 CNS 受累的类似患者（匹配白细胞计数和完全缓解时间）相比，经历孤立性 CNS 复发的患者的血液学复发或死亡风险明显增加 2 至 3.5 倍。在 107 名最初出现中枢神经系统孤立复发的儿童中，89 名 (83%) 已经死亡或随后出现复发。接受预防性治疗的患者与未接受预防性治疗的患者之间，中枢神经系统复发后的血液学复发率或死亡率没有明显差异。中枢神经系统预防对于预防初始中枢神经系统白血病和降低中枢神经系统复发后血液学复发或死亡的风险显然很重要。
The influence of an initial isolated meningeal relapse on treatment outcome in 839 children with acute lymphoblastic leukemia (ALL) who were admitted to St Jude Children''s Research Hospital (Memphis) from mid-1967-mid-1979 was assessed. The patients were entered in a series of 5 clinical trials (total therapy studies V-IX), each designed to test 1 or more modifications of treatment for ALL. Two groups were compared: 699 children who received CNS prophylaxis (2,400-rad craniospinal irradiation or 2400-rad cranial irradiation plus intrathecal methotrexate) vs. 56 who did not. With a time-dependent covariate model and a matching technique, a 2- to 3.5-fold increase was apparently indicated in the risk of hemotologic relapse or death among patients who experienced an isolated CNS relapse compared with similar patients (matched for leukocyte count and length of complete remission) who remained free of CNS involvement. Of the 107 children with an initial isolated CNS relapse, 89 (83%) have died or have had a subsequent relapse. There was no detectable difference in the rate of hematologic relapse or death after a CNS relapse between patients who had received preventive therapy and those who had not. CNS prophylaxis apparently important both for the prevention of initial CNS leukemia and for reducing the risk of hematologic relapse or death subsequent to a CNS relapse.