Completion of leukaemia trials

40年前，几乎没有人能治愈白血病。然而，如今，在英国等国家，大多数患上这种疾病的儿童和年轻人都被完全治愈，他们及其后代可能不会因这种疾病或治疗而产生任何不良的晚期影响。虽然完全治愈在老年白血病患者中不太常见，但有时可以实现，即使这种疾病无法治愈，现在也有可能延长缓解期并获得良好的生活质量。大多数进展并不涉及容易被认可的巨大突破，而是一系列渐进的改善，每一个都太小，如果没有大型随机试验，其中一半患者接受一种治疗，另一半接受另一种治疗，然后对两组患者进行多年随访，就无法可靠地识别。事实上，只有当所有曾经进行过这种随机试验的人之间进行全球合作时，才能可靠地认识到治疗的一些适度改善。多年来，CTSU协调了英国全国性的白血病试验，目前的申请是为了让我们在未来4年内继续参与。然而，白血病试验需要4年多的时间才能完成，因此未来4年出现的主要结果将来自数百甚至数千名患者的试验，以及CTSU已经部分建立的涉及数千甚至数万名患者的全球合作。其中一些研究，在新的基因和其他测试的帮助下，现在已经可以对当前和过去的MRC白血病试验中储存的数千个样本进行测试，可能会显示某些特定类型的患者将从更密集的治疗中获得长期净收益，而其他患者则不会。CTSU的明确结果可以迅速改变临床实践，并可以很好地挽救生命和金钱。

Forty years ago almost nobody was cured of leukaemia. Nowadays, however, in countries such as the UK most children and young adults who develop the disease are completely cured, and they and their descendants will probably have no adverse late effects from it or its treatment. Although complete cure is less common among older leukaemia patients it is sometimes achieved, and even if the disease cannot be cured, prolonged remission with a good quality of life may nowadays be possible. Most of this progress has involved not huge breakthroughs that could easily be recognised as such, but a series of gradual improvements, each too small to be recognised reliably without large randomised trials in which half the patients got one treatment, half got another, and both groups of patients were then followed up for many years. Indeed, some moderate improvements in treatment could be reliably recognised as such only when there was worldwide collaboration between all who had ever conducted such a randomised trial of it. For many years the CTSU has coordinated nationwide UK leukaemia trials and the present application is to allow us to continue our involvement over the next 4 years. Leukaemia trials take far more than 4 years to complete, however, so the main results emerging over the next 4 years will be from trials that are already in progress among many hundreds, or even thousands, of patients, and from worldwide collaborations that the CTSU has already partly established, involving thousands or even tens of thousands of patients. Some of these studies, helped by the new genetic and other tests that are now becoming possible on the many thousands of stored samples from current and past MRC leukaemia trials, will probably show that some particular types of patient will gain net long-term benefit from more intensive treatment, and that other patients will not. Clear results from the CTSU can quickly change clinical practice, and could well save both lives and money.