TREATMENT OF CHILDHOOD ACUTE LYMPHOBLASTIC-LEUKEMIA - RESULTS OF DANA-FARBER-CANCER-INSTITUTE CHILDRENS-HOSPITAL ACUTE LYMPHOBLASTIC-LEUKEMIA CONSORTIUM PROTOCOL-85-01

被引:168
作者
SCHORIN, MA
BLATTNER, S
GELBER, RD
TARBELL, NJ
DONNELLY, M
DALTON, V
COHEN, HJ
SALLAN, SE
机构
[1] DANA FARBER CANC INST,DEPT PEDIAT ONCOL,BOSTON,MA 02115
[2] DANA FARBER CANC INST,DIV BIOSTAT,BOSTON,MA
[3] CHILDRENS HOSP,DEPT RADIAT ONCOL,BOSTON,MA
[4] CHILDRENS HOSP,DIV HEMATOL ONCOL,BOSTON,MA
[5] JOINT CTR RADIAT ONCOL,BOSTON,MA
[6] HARVARD UNIV,SCH MED,DEPT PEDIAT,BOSTON,MA
[7] HARVARD UNIV,SCH PUBL HLTH,DEPT BIOSTAT,BOSTON,MA
[8] OCHSNER MED INST,DEPT PEDIAT,NEW ORLEANS,LA
[9] MAINE MED CTR,DEPT PEDIAT,PORTLAND,ME
[10] UNIV ROCHESTER,MED CTR,DEPT PEDIAT,ROCHESTER,NY
[11] UNIV ROCHESTER,MED CTR,CTR CANC,ROCHESTER,NY
关键词
D O I
10.1200/JCO.1994.12.4.740
中图分类号
R73 [肿瘤学];
学科分类号
100214 ;
摘要
Purpose: The goals of this treatment program were as follows: to improve event-free survival (EFS) rates for high-risk (HR) patients by increasing the intensity of induction treatment; to improve EFS rates for infants by adding a special postinduction intensification; to treat the CNS using cranial irradiation doses that were lower than in our historic control group; and to confirm our previously obtained good results for children with T-cell disease. Patients and Methods: Two hundred twenty children with acute lymphoblastic leukemia (ALL) from all risk groups, including infants and patients with T-cell disease, were treated between 1985 and 1987 with multiagent chemotherapy and cranial irradiation. Results: The 7-year EFS rate (± SE) for all 220 patients was 78% ± 3% at a median follow-up duration of 6.2 years, 89% ± 4% for the 82 patients classified as standard risk (SR), and 72% ± 4% for the remaining 138 patients classified as HR and very high risk (VHR). Eleven infants had an EFS rate of 55% ± 15% that might be attributable to treatment with high doses of methotrexate and cytarabine (ara-c). Twenty children with T-cell disease had an EFS rate of 70% ± 10%. CNS leukemia relapse (isolated or combined with bone marrow) occurred in four of 82 SR patients who received 18 Gy of cranial irradiation and four of 138 HR and VHR patients who received 24 Gy. Conclusion: This protocol, which featured early intensive treatment including asparaginase, doxorubicin, and cranial irradiation, provided good long-term disease control for children with ALL.
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收藏
页码:740 / 747
页数:8
相关论文
共 21 条
  • [1] ASSELIN BL, 1989, CANCER RES, V49, P4363
  • [2] 4-AGENT INDUCTION AND INTENSIVE ASPARAGINASE THERAPY FOR TREATMENT OF CHILDHOOD ACUTE LYMPHOBLASTIC-LEUKEMIA
    CLAVELL, LA
    GELBER, RD
    COHEN, HJ
    HITCHCOCKBRYAN, S
    CASSADY, JR
    TARBELL, NJ
    BLATTNER, SR
    TANTRAVAHI, R
    LEAVITT, P
    SALLAN, SE
    [J]. NEW ENGLAND JOURNAL OF MEDICINE, 1986, 315 (11) : 657 - 663
  • [3] COX DR, 1972, J R STAT SOC B, V34, P187
  • [4] CRIST W, 1986, BLOOD, V67, P135
  • [5] FLETCHER JA, 1989, BLOOD, V74, P2130
  • [6] FLETCHER JA, 1991, BLOOD, V77, P439
  • [7] Greenwood M., 1926, REPORTS PUBLIC HLTH, V33, P1
  • [8] EXPERIENCE WITH PREVENTIVE CENTRAL NERVOUS-SYSTEM THERAPY IN 275 CHILDREN WITH ACUTE LYMPHOBLASTIC-LEUKEMIA
    HENZE, G
    LANGERMANN, HJ
    BRAMSWIG, J
    SCHELLONG, G
    LUDWIG, R
    RIEHM, H
    [J]. KLINISCHE PADIATRIE, 1983, 195 (03): : 168 - 175
  • [9] INATI A, 1983, BLOOD, V61, P297
  • [10] NONPARAMETRIC-ESTIMATION FROM INCOMPLETE OBSERVATIONS
    KAPLAN, EL
    MEIER, P
    [J]. JOURNAL OF THE AMERICAN STATISTICAL ASSOCIATION, 1958, 53 (282) : 457 - 481