多中心协作方案(MCP)序贯治疗儿童急淋白血病和晚期淋巴瘤的远期疗效

Chemotherapy for Childhood Lymphoblastic Leukemia and Late Stage Non-Hodgkin's Lymphoma with Multicenter Protocols

：为提高儿童急性淋巴细胞白血病（ＡＬＬ）和晚期非霍杰金淋巴瘤（ＮＨＬ）的远期疗效，采用美国国立癌症研究所（ＮＩＣ）推荐的ＭＣＰ方案长期治疗儿童ＡＬＬ和晚期ＮＨＬ。方法：（１）病例：病儿３０例。其中２０例ＡＬＬ，１０例ＮＨＬ（Ⅲ期和Ⅳ期各５例），均为初发病例。（２）化疗方案：（ａ）ＡＬＬ和Ⅳ期ＮＨＬ采用ＭＣＰ－８４１方案，总疗程３～５年，包括①诱导１（Ｉ１）：ＰＶＤＬ，力争首次诱导获ＣＲ。②诱导２（Ｉ２）：ＣＡＴ（以大剂量阿糖胞苷为主）。③巩固（Ｃ）：ＣＯＡＴ。④早期强化：同诱导１。早期治疗阶段共８疗程，顺序为：Ｉ１×１，Ｉ２×３，Ｉ１×１，Ｃ×２，Ｉ１×１疗程。⑤维护治疗（Ｍ）：６ＭＰ＋ＭＴＸ和Ｐｒｅｄ＋ＶＣＲ方案交替。⑥定期强化：维持治疗中每３个月一次，选择诱导１，巩固方案和ＡｒａＣ＋ＶＰ１６方案。⑦三联鞘注（ＡｒａＣ，ＭＴＸ，ＤＸ）：早期诱导时４次，以后每月１次，维持期间每３月１次。（ｂ）Ⅲ期ＮＨＬ应用ＭＣＰ－８４２方案，包括Ａ方案：ＣＴＸ，ＡＤＲ，ＭＤ－ＡｒａＣ，ＶＣＲ；方案：Ｉｆｏ，ＭＴＸ，ＶＰ１６，ＶＣＲ早期治疗Ａ、Ｂ、Ａ、Ｂ共４疗程。ＣＲ后应用经典方案ＣＨＯＰ和ＣＯＭＰ维持治疗，每３个月交替应用?

Objective:This paper described the clinical results of the intensive chemotherapy for childhood lymphoblastic leukemia(ALL) and late stage non-Hodgkin's lymphoma (NHL) with multicenter protocals (MCP) introduced from NCI of USA. Methods: 30 cases of childhood patients were in the study.There were 20 cases of ALL and 10 cases of NHL(5 cases of Ⅲ stage and 5 cases of Ⅳ stage).ALL and Ⅳ stage NHL were treated with MCP-841 consisted of induction 1(11,PVDL),induction 2(12,combined chemotherapy with high-dose AraC),consolidation (C) and maintenance(M) with regular intensive regimens.Ⅲ stage NHL was treated with MCP-842 consisted with A regimen(CTX,ADR,MD-AraC,VCR)and B regimen(Ifo,VP16,MTx,VCR)for induction,CHOP and COMP for maintenance.Regular intrathecal injection of AraC,MTX and DX for prophylaxis of CNSL of NHL as well as ALL. Results:All 30 cases of ALL and NHL got CR after induction chemotherapy,the CR rate was 100%, up to date, 26 cases (21 cases of ALL and Ⅵ stage NHL, 5 cases of Ⅲ stage of NHL)were still CR for 6 to 60 months (everage 26 months).Only 4 cases relapsed. No one complicated with CNSL,and no one died of the complications of intensive chemotherapy.The rate of CCR achieved 86 75%(26/30).Conclusion: Our results showed that MCP was very effective for childhood ALL and late stage NHL. It might be due to continuous intensive chemotherapy, high-dose AraC for prophylaxis of CNSL,Ⅳ stage NHL treated as ALL,and more intensive regimens for Ⅲ stage NHL.