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J Clin Oncol：高危B-ALL患者来说，接受大剂量甲氨蝶呤治疗可更好地改善其生存率

2016-07-31 MedSci MedSci原创

B-ALL地塞米松甲氨蝶呤
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儿童和年轻成人高危B-急性淋巴细胞白血病（B-ALL）的预后已明显改善，但是仍有20-25%的患者并不能治愈。儿童肿瘤学小组AALL0232测试了两项干预措施以提高患者的生存率。 2004年1月至2011年1月研究人员共纳入了3154名新诊断为高危B-ALL的患者，年龄为1-30岁。采用2 × 2析因设计，将2914名患者随机分至诱导期接受地塞米松（14天）VS.泼尼松（28天）治疗，中间维

儿童和年轻成人高危B-急性淋巴细胞白血病（B-ALL）的预后已明显改善，但是仍有20-25%的患者并不能治愈。儿童肿瘤学小组AALL0232测试了两项干预措施以提高患者的生存率。

2004年1月至2011年1月研究人员共纳入了3154名新诊断为高危B-ALL的患者，年龄为1-30岁。采用2 × 2析因设计，将2914名患者随机分至诱导期接受地塞米松（14天）VS.泼尼松（28天）治疗，中间维持期1接受大剂量的甲氨蝶呤VS.剂量递增Capizzi甲氨蝶呤联合天门冬酰胺酶治疗。

中期数据显示大剂量甲氨蝶呤治疗的效果超过预期。中间维持期1接受大剂量甲氨蝶呤治疗的患者其5年安全生存率（EFS）高于接受Capizzi甲氨蝶呤的患者（82% vs 75.4%）。

最终数据显示，大剂量甲氨蝶呤组患者的5年EFS率较Capizzi甲氨蝶呤高（79.6% vs 75.2%）。大剂量甲氨蝶呤治疗降低了患者骨髓和CNS的复发风险。与其他三种治疗方案相比，1-9岁的患者接受强的松和大剂量甲氨蝶呤治疗其预后更好（5年EFS，91.2% v 83.2%，80.8%和82.1%； P = 0.015）。而对于年龄相对较大的患者来说，诱导治疗期间接受地塞米松诱导治疗并不能改善患者预后，且患者股骨头坏死率较高。

总而言之，该研究表明，对于高危B-ALL患者来说，接受大剂量甲氨蝶呤治疗其效果优于Capizzi 甲氨蝶呤，且不会增加急性毒副作用。诱导期间接受地塞米松治疗对年龄<10岁的患者来说存在益处，而对于年龄>10岁的患者来说则并不会获益，同时还会增加股骨头坏死的风险。


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    2016-09-14 1def5ef1m18(暂无匿称)

    学习学习再学习！

    0

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    2016-09-13 1def5ef1m18(暂无匿称)

    学习再学习！

    0

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    2016-09-11 1def5ef1m18(暂无匿称)

    看到了！好好学习！

    0

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    2016-09-10 1def5ef1m18(暂无匿称)

    看了十多遍啦！

    0

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    2016-09-09 1def5ef1m18(暂无匿称)

    换一篇文章吧！

    0

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    2016-09-08 ylzr123

    好文章，赞一个！深入学习，探究。

    0

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    2017-01-31 minlingfeng

    #Oncol#

    0

  8. [GetPortalCommentsPageByObjectIdResponse(id=125882, encodeId=5f7c12588281, content=学习学习再学习！, beContent=null, objectType=article, channel=null, level=null, likeNumber=111, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=118f1734484, createdName=1def5ef1m18(暂无匿称), createdTime=Wed Sep 14 00:18:00 CST 2016, time=2016-09-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=124092, encodeId=25b012409255, content=学习再学习！, beContent=null, objectType=article, channel=null, level=null, likeNumber=130, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=118f1734484, createdName=1def5ef1m18(暂无匿称), createdTime=Tue Sep 13 00:33:00 CST 2016, time=2016-09-13, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=121997, encodeId=bfda12199efc, content=看到了！好好学习！, beContent=null, objectType=article, channel=null, level=null, likeNumber=98, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=118f1734484, createdName=1def5ef1m18(暂无匿称), createdTime=Sun Sep 11 07:55:00 CST 2016, time=2016-09-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=121681, encodeId=ea6412168108, content=看了十多遍啦！, beContent=null, objectType=article, channel=null, level=null, likeNumber=153, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=118f1734484, createdName=1def5ef1m18(暂无匿称), createdTime=Sat Sep 10 23:11:00 CST 2016, time=2016-09-10, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=114743, encodeId=aaeb114e43ff, content=换一篇文章吧！, beContent=null, objectType=article, channel=null, level=null, likeNumber=138, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=118f1734484, createdName=1def5ef1m18(暂无匿称), createdTime=Fri Sep 09 06:34:00 CST 2016, time=2016-09-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=113651, encodeId=ad161136511a, content=好文章，赞一个！深入学习，探究。, beContent=null, objectType=article, channel=null, level=null, likeNumber=90, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo7s7ZCKOmmbBTD6nE7gcd5OZpvyGEzkxBP3S275k5ZJVrsPkotZhBglRHM9rKvcj1OgkssqhcnoPw8zIaMZTF8c/0, createdBy=4c441942088, createdName=ylzr123, createdTime=Thu Sep 08 13:16:00 CST 2016, time=2016-09-08, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1864783, encodeId=e2ba1864e8326, content=<a href='/topic/show?id=16ce133504e' target=_blank style='color:#2F92EE;'>#Oncol#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=117, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=13350, encryptionId=16ce133504e, topicName=Oncol)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=b63894, createdName=minlingfeng, createdTime=Tue Jan 31 20:44:00 CST 2017, time=2017-01-31, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=113488, encodeId=79f3113488f9, content=看看了！, beContent=null, objectType=article, channel=null, level=null, likeNumber=130, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=118f1734484, createdName=1def5ef1m18(暂无匿称), createdTime=Thu Sep 08 07:00:00 CST 2016, time=2016-09-08, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=113354, encodeId=8a6f11335492, content=换文章吧！, beContent=null, objectType=article, channel=null, level=null, likeNumber=46, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=118f1734484, createdName=1def5ef1m18(暂无匿称), createdTime=Wed Sep 07 21:55:00 CST 2016, time=2016-09-07, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=111970, encodeId=ffba1119e0b0, content=换文字辈啦！, beContent=null, objectType=article, channel=null, level=null, likeNumber=85, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=118f1734484, createdName=1def5ef1m18(暂无匿称), createdTime=Tue Sep 06 06:29:00 CST 2016, time=2016-09-06, status=1, ipAttribution=)]
    2016-09-08 1def5ef1m18(暂无匿称)

    看看了！

    0

  9. [GetPortalCommentsPageByObjectIdResponse(id=125882, encodeId=5f7c12588281, content=学习学习再学习！, beContent=null, objectType=article, channel=null, level=null, likeNumber=111, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=118f1734484, createdName=1def5ef1m18(暂无匿称), createdTime=Wed Sep 14 00:18:00 CST 2016, time=2016-09-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=124092, encodeId=25b012409255, content=学习再学习！, beContent=null, objectType=article, channel=null, level=null, likeNumber=130, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=118f1734484, createdName=1def5ef1m18(暂无匿称), createdTime=Tue Sep 13 00:33:00 CST 2016, time=2016-09-13, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=121997, encodeId=bfda12199efc, content=看到了！好好学习！, beContent=null, objectType=article, channel=null, level=null, likeNumber=98, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=118f1734484, createdName=1def5ef1m18(暂无匿称), createdTime=Sun Sep 11 07:55:00 CST 2016, time=2016-09-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=121681, encodeId=ea6412168108, content=看了十多遍啦！, beContent=null, objectType=article, channel=null, level=null, likeNumber=153, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=118f1734484, createdName=1def5ef1m18(暂无匿称), createdTime=Sat Sep 10 23:11:00 CST 2016, time=2016-09-10, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=114743, encodeId=aaeb114e43ff, content=换一篇文章吧！, beContent=null, objectType=article, channel=null, level=null, likeNumber=138, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=118f1734484, createdName=1def5ef1m18(暂无匿称), createdTime=Fri Sep 09 06:34:00 CST 2016, time=2016-09-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=113651, encodeId=ad161136511a, content=好文章，赞一个！深入学习，探究。, beContent=null, objectType=article, channel=null, level=null, likeNumber=90, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo7s7ZCKOmmbBTD6nE7gcd5OZpvyGEzkxBP3S275k5ZJVrsPkotZhBglRHM9rKvcj1OgkssqhcnoPw8zIaMZTF8c/0, createdBy=4c441942088, createdName=ylzr123, createdTime=Thu Sep 08 13:16:00 CST 2016, time=2016-09-08, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1864783, encodeId=e2ba1864e8326, content=<a href='/topic/show?id=16ce133504e' target=_blank style='color:#2F92EE;'>#Oncol#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=117, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=13350, encryptionId=16ce133504e, topicName=Oncol)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=b63894, createdName=minlingfeng, createdTime=Tue Jan 31 20:44:00 CST 2017, time=2017-01-31, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=113488, encodeId=79f3113488f9, content=看看了！, beContent=null, objectType=article, channel=null, level=null, likeNumber=130, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=118f1734484, createdName=1def5ef1m18(暂无匿称), createdTime=Thu Sep 08 07:00:00 CST 2016, time=2016-09-08, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=113354, encodeId=8a6f11335492, content=换文章吧！, beContent=null, objectType=article, channel=null, level=null, likeNumber=46, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=118f1734484, createdName=1def5ef1m18(暂无匿称), createdTime=Wed Sep 07 21:55:00 CST 2016, time=2016-09-07, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=111970, encodeId=ffba1119e0b0, content=换文字辈啦！, beContent=null, objectType=article, channel=null, level=null, likeNumber=85, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=118f1734484, createdName=1def5ef1m18(暂无匿称), createdTime=Tue Sep 06 06:29:00 CST 2016, time=2016-09-06, status=1, ipAttribution=)]
    2016-09-07 1def5ef1m18(暂无匿称)

    换文章吧！

    0

  10. [GetPortalCommentsPageByObjectIdResponse(id=125882, encodeId=5f7c12588281, content=学习学习再学习！, beContent=null, objectType=article, channel=null, level=null, likeNumber=111, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=118f1734484, createdName=1def5ef1m18(暂无匿称), createdTime=Wed Sep 14 00:18:00 CST 2016, time=2016-09-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=124092, encodeId=25b012409255, content=学习再学习！, beContent=null, objectType=article, channel=null, level=null, likeNumber=130, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=118f1734484, createdName=1def5ef1m18(暂无匿称), createdTime=Tue Sep 13 00:33:00 CST 2016, time=2016-09-13, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=121997, encodeId=bfda12199efc, content=看到了！好好学习！, beContent=null, objectType=article, channel=null, level=null, likeNumber=98, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=118f1734484, createdName=1def5ef1m18(暂无匿称), createdTime=Sun Sep 11 07:55:00 CST 2016, time=2016-09-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=121681, encodeId=ea6412168108, content=看了十多遍啦！, beContent=null, objectType=article, channel=null, level=null, likeNumber=153, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=118f1734484, createdName=1def5ef1m18(暂无匿称), createdTime=Sat Sep 10 23:11:00 CST 2016, time=2016-09-10, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=114743, encodeId=aaeb114e43ff, content=换一篇文章吧！, beContent=null, objectType=article, channel=null, level=null, likeNumber=138, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=118f1734484, createdName=1def5ef1m18(暂无匿称), createdTime=Fri Sep 09 06:34:00 CST 2016, time=2016-09-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=113651, encodeId=ad161136511a, content=好文章，赞一个！深入学习，探究。, beContent=null, objectType=article, channel=null, level=null, likeNumber=90, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo7s7ZCKOmmbBTD6nE7gcd5OZpvyGEzkxBP3S275k5ZJVrsPkotZhBglRHM9rKvcj1OgkssqhcnoPw8zIaMZTF8c/0, createdBy=4c441942088, createdName=ylzr123, createdTime=Thu Sep 08 13:16:00 CST 2016, time=2016-09-08, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1864783, encodeId=e2ba1864e8326, content=<a href='/topic/show?id=16ce133504e' target=_blank style='color:#2F92EE;'>#Oncol#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=117, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=13350, encryptionId=16ce133504e, topicName=Oncol)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=b63894, createdName=minlingfeng, createdTime=Tue Jan 31 20:44:00 CST 2017, time=2017-01-31, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=113488, encodeId=79f3113488f9, content=看看了！, beContent=null, objectType=article, channel=null, level=null, likeNumber=130, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=118f1734484, createdName=1def5ef1m18(暂无匿称), createdTime=Thu Sep 08 07:00:00 CST 2016, time=2016-09-08, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=113354, encodeId=8a6f11335492, content=换文章吧！, beContent=null, objectType=article, channel=null, level=null, likeNumber=46, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=118f1734484, createdName=1def5ef1m18(暂无匿称), createdTime=Wed Sep 07 21:55:00 CST 2016, time=2016-09-07, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=111970, encodeId=ffba1119e0b0, content=换文字辈啦！, beContent=null, objectType=article, channel=null, level=null, likeNumber=85, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=118f1734484, createdName=1def5ef1m18(暂无匿称), createdTime=Tue Sep 06 06:29:00 CST 2016, time=2016-09-06, status=1, ipAttribution=)]
    2016-09-06 1def5ef1m18(暂无匿称)

    换文字辈啦！

    0

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