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，大多数患有这种疾病的儿童和年轻人已经完全治愈，他们和他们的后代可能不会因这种疾病或其治疗而产生不良的晚期影响。尽管完全治愈在老年白血病患者中不太常见，但有时是可以实现的，即使疾病无法治愈，如今也有可能长期缓解并获得良好的生活质量。这些进展中的大多数并不是很容易被认识到的巨大突破，而是一系列渐进的改善，每一项都太小，如果没有大型随机试验，每一项都无法可靠地被认识到。在大型随机试验中，一半的患者接受了一种治疗，另一半接受了另一种治疗，然后对两组患者进行了多年的跟踪调查。事实上，只有当所有曾经进行过这种随机试验的人在全球范围内合作时，治疗方面的一些适度改善才能得到可靠的承认。多年来，CTSU一直在协调全国范围内的英国白血病试验，目前的申请是为了让我们在未来4年继续参与。然而，白血病试验需要远远超过4年的时间才能完成，因此未来4年出现的主要结果将来自已经在数百名甚至数千名患者中进行的试验，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。这些研究中的一些研究，得益于对目前和过去MRC白血病试验中储存的数千份样本进行的新的基因和其他测试，可能会表明，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，并很好地拯救生命和金钱。

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.