成人急性淋巴细胞白血病的治疗.ppt

文档介绍：***急性淋巴细胞白血病的治疗
ALL化学治疗
诱导治疗
自发缓解
VCR + Pred(VP)诱导, CR 36 – 67%
VCR + DNR + Pred (VDP)诱导,CR 70 – 85%
VCR + DNR + L-Asp + Pred (VDLP)—缓解期延长
VCR + DNR + CTX + Pred (VDCP)
缓解后治疗
T-ALL :大剂量CTX冲击+ Ara-C
成熟B-ALL:短疗程诱导及强化治疗
中枢系统白血病的预防及治疗
Remission Induction Regimens And Postremission Therapy for ALL
No. S Survival Reference patients Induction Consolidation Maintenance Prophylaxis CR% Med(mo)
Blood 368 V, P, D, Cy, Dex, V, Dox, Cy 6-MP, MTX MTX, XRT 74 28
71:123, 1988 Ara-c, 6-MP Ara-C, TG
Blood 168 V, P, Dox, Cy Ara-C, MTX, TG V, P, Dox, 6-MP MTX 68 18
73:87, 1989 V, P, A, Cy MTX, ActD, Cy
BCNU
Blood 109 V, P, A, D V, P, A, D 6-MP, MTX MTX, XRT 88 28
78:2814, 1991 Ara-c, VM26, MTX
Leukemia 541 V, P, D, A V, P, Mito; 6-MP, MTX MTX 80 NR
6:182, 1992  Cy V, Dex, MTX;
VM26, Ara-C
Blood 197 V, P, A, D, Cy Cy, Ara-c, 6-MP, V 6-MP, MTX MTX, XRT 85 36
85:78:2814, 1995 A, Dox, Dex, TG V, P
Blood 128 Cy, V, Dox, Dex MTX, Ara-C 6-MP, MTX, V, P MTX, Ara-C 91 36
86:173a, 1995
Group Year n (pts) Age* Induction Consolidation Maintenance CR LFS
Studies with > 500 patients
GMALL 02/84 1993 562 28 V,P,A,D,C,AC,M,MP V,DX,AD,AC,C,TG,VM MP,M 75% 39%at7y
FGTALL 1993 581 33 V,P,D/R,C [AD,AC] AD,AC,A MP,M,V,C,P,AD,AC 76% 30%at10y
MRC-UKALL XA 3 1997 618 >15 V,P,A,D [AC,VP,D,TG] MP,M,V,P 82% 28% at5y
MRC/ECOG 4 1999 920 V,P,D,A,C,AC,MP HDM,A [AC,VP,V,DX, MP,M,V,P 89%
D, C,TG] ± SCT
GMALL 05/93 5 2001 1163 35 V,P,A,D,C,AC,M,MP V,DX,AD,AC,C,TG,VM, MP,M 83%
AC,HDM, A, C[HDAC,Mi]
GIMEMA 0288 6 2002 794 28 V,P,A,D,C,[HDAC,Mi] V,HDM,HDAC,DX,VM MP,M,V,[AC,Mi,VM, 82% 29% at9y
HDAC,HDM,DX]
Total 4638 82% 31%
(%=weighted mean)
Results of adult acute lymphoblastic leukemia (ALL) studies(1)
Dieter Hoelzer,et al,Hematology,2002 164-191
Results of adult acute lymphoblastic leukemia (ALL) studies(2)
Group Year n (pts) Age* Induction Consolidation Maintenance CR LFS
Recent Studies with > 100 patients
Pethema ALL-93 7 1998 108 28 V,P,D,A,C HDM,V,D,P,A,C,VM,AC MP,M [V, P, Mi, 86% 41%