成人急性淋巴细胞白血病的治疗课件

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1、成人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，CR36–67%VCR+DNR+Pred（VDP）诱导，CR70–85%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RemissionInductionRegimensAndPostremissionTherapyforALLNo.ofCNSSurvivalReferencepatientsInductionConsolidationMa

2、intenanceProphylaxisCR%Med(mo)Blood368V,P,D,Cy,Dex,V,Dox,Cy6-MP,MTXMTX,XRT742871:123,1988Ara-c,6-MPAra-C,TGBlood168V,P,Dox,CyAra-C,MTX,TGV,P,Dox,6-MPMTX681873:87,1989V,P,A,CyMTX,ActD,CyBCNUBlood109V,P,A,DV,P,A,D6-MP,MTXMTX,XRT882878:2814,1991Ara-c,VM26,MTXLeukemia541V,P,D,AV,P,Mito;6-MP,MTXMTX80NR6:

3、182,1992CyV,Dex,MTX;VM26,Ara-CBlood197V,P,A,D,CyCy,Ara-c,6-MP,V6-MP,MTXMTX,XRT853685:78:2814,1995A,Dox,Dex,TGV,PBlood128Cy,V,Dox,DexMTX,Ara-C6-MP,MTX,V,PMTX,Ara-C913686:173a,1995GroupYearn(pts)Age*InductionConsolidationMaintenanceCRLFSStudieswith>500patientsGMALL02/84199356228V,P,A,D,C,AC,M,MPV,DX,

4、AD,AC,C,TG,VMMP,M75%39%at7yFGTALL199358133V,P,D/R,C[AD,AC]AD,AC,AMP,M,V,C,P,AD,AC76%30%at10yMRC-UKALLXA31997618>15V,P,A,D[AC,VP,D,TG]MP,M,V,P82%28%at5yMRC/ECOG41999920V,P,D,A,C,AC,MPHDM,A[AC,VP,V,DX,MP,M,V,P89%D,C,TG]±SCTGMALL05/9352001116335V,P,A,D,C,AC,M,MPV,DX,AD,AC,C,TG,VM,MP,M83%AC,HDM,A,C[HDAC

5、,Mi]GIMEMA02886200279428V,P,A,D,C,[HDAC,Mi]V,HDM,HDAC,DX,VMMP,M,V,[AC,Mi,VM,82%29%at9yHDAC,HDM,DX]Total463882%31%(%=weightedmean)Resultsofadultacutelymphoblasticleukemia(ALL)studies(1)DieterHoelzer,etal,Hematology,2002164-191Resultsofadultacutelymphoblasticleukemia(ALL)studies(2)GroupYearn(pts)Age*I

6、nductionConsolidationMaintenanceCRLFSRecentStudieswith>100patientsPethemaALL-937199810828V,P,D,A,CHDM,V,D,P,A,C,VM,ACMP,M[V,P,Mi,86%41%at4yA,C,VM,AC]CALGB8199819835V,P,D,A,CC,MP,AC,V,A,M,AD,DX,TG,PMP,M,V,P85%36%at3ySweden9199912044HDAC,C,D,V,BXAD,HDAC,V,BX,C,D,n.r.85%36%at3yVP±SCTMDACC10200020439V,A

7、D,DX,CHDM,HDAC,C,PMP,M,V,P91%38%at5yLombardia11200112135I,V,A,P,[C]I,V,C,VM,HDAC,HDM,MP,M84%49%at3yDX±SCTNetherlands12200119333StandardHDAC,VP16+allo/autoSC—82%35%at5yTotal94486%38%(%=weightedmean)Die