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題 名 | Acute Lymphoblastic Leukemia in Young Adults: Two Chemotherapeutic Protocols for the Treatment of 46 Patients=兩種不同化學治療對46位年輕成年急性淋巴性白血病患者的療效 |
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作 者 | 何景良; 陳宇欽; 高偉堯; 趙祖怡; | 書刊名 | 中華醫學雜誌 |
卷 期 | 63:1 2000.01[民89.01] |
頁 次 | 頁45-52 |
分類號 | 415.635 |
關鍵詞 | 急性淋巴性白血病; 緩解期; GMALL化學治療; 存活期; Acute lymphoblastic leukemia; GMALL protocol; Remission; Survival; |
語 文 | 英文(English) |
中文摘要 | 背景 成年急性淋巴性白血病患者均帶有預後不佳的因子。很多化學治療藥物被 用來治療成年急性白血病患者,以改善其療效。本院曾使用兩種不同的化學治療處方來治療 年輕成年急性淋巴性白血病患者,我們在此報告其療效。 方法 從 1984-1997 年,共有 46 位年輕成年急性淋巴性白血病患者在本院接受治療, 其 中男性 43 位,女性 3 位,平均年齡 24 歲( 16-38 歲)。其中有 32 位患者接受傳統的 化學治療處方,包括誘導期、腦部預防期及維持期的化學治療( A 組)。 另外 14 位患者 接受 GMALL 化學治療處方, 包括兩個週期的誘導期、腦部預防期、維持期及鞏固期的化學 治療( B 組)。 結果 在 A 組患者中,25 位( 78.1% )完全緩解, 3 位部份緩解,4 位在誘導期治療後 產生併發症而死亡, 平均緩解期及存活期分別為 12 ( 3-39 個月)及 13 個月( 0.5-50 個月)。在 25 位完全緩解的患者中,有 21 位因復發而死亡。在 B 組患者中,11 位完全 緩解,3 位因治療導致白血球過低,產生感染性併發症而死亡,平均緩解期及存活期分別為 12 ( 8-37 個月)及 15 個月( 0.5-39 個月)。 在 11 位完全緩解的患者中,有 10 位 因復發而死亡,只有 1 位在第 1 次緩解期後即接受異體骨髓移植,目前仍存活。比較兩組 患者的療效, 完全緩解率、緩解期及存活期並無統計學意義,但 GMALL 化學治療在誘導期 有較顯著的血液毒性。 結論 我們的結果顯示,年輕成年急性淋巴性白血病患者的預後相當差,而目前所用的傳統 化學治療是不足的。 但是,我們的結果亦無法證實 GMALL 化學治療處方優於傳統的化學治 療處方。 |
英文摘要 | Background. Acute lymphoblastic leukemia (ALL) in adults has a very poor prognosis. Many chemotherapeutic protocols have been designed to try to improve treatment results for adult ALL. Two chemotherapeutic protocols were used to treat young adult ALL patients in our institute and treatment results are reported. Methods. From 1984 through 1997, 46 young adult patients with ALL were treated. There were 43 males and three females. Their ages ranged from 16 to 38 years, with a median of 24 years. Thirty-two patients (group A) received a four-week conventional induction regimen with daunomycin, vincristine, prednisolone, and L-asparaginase, followed by prophylaxis of the central nervous system (CNS) with intrathecal methotrexate and cranial irradiation, as well as maintenance therapy with oral 6-mercaptopurine and methotrexate. Fourteen patients (group B) received the modified protocol of the German multicenter trial for adult ALL (GMALL) with a two-phase induction regimen, CNS prophylaxis and maintenance therapy. Results. In group A, 25 of 32 patients achieved complete remission (CR), three obtained partial remission and four died of treatment-related complications during induction therapy. The median duration of remission (DR) was 12 months (range, 3-39 months) and the median overall survival time (OST) was 13 months (range, 0.5-50 months). Of the 25 patients who achieved CR, 21 relapsed and died. In group B, 11 of 14 patients obtained CR and three died of leukopenia-related infectious complications during induction. The median DR was 12 months (range, 8-37 months) and the median OST was 15 months (range, 0.5-39 months). During follow-up, 10 of 11 patients relapsed from ALL and died. Only one patient who received allogeneic bone marrow transplantation first CR is still alive. No statistical differences between the two groups were noted in terms of CR rate, DR (p=0.87) and OST (p=0.34). However, the the GMALL protocol had during the significantly more hematologic toxicity during induction therapy. Conclusions. Our results suggest that young adult ALL is a disease with a very poor prognosis and conventional chemotherapy is not adequate for its treatment. The notion that GMALL protocol is better than conventional therapy in the treatment of adult ALL cannot be justified by our data. |
本系統中英文摘要資訊取自各篇刊載內容。