Study on effect of sanctuary phylaxis with different therapies
for children’s Acute Lymphoblastic Leukemia
Wu MY, Hu YM, Zhang RD, Geng LZ, Shi HW, Zhang YH
The Hematological Centre, Beijing Children’s Hospital, Beijing,
China
Objective: To study the effect of sanctuary phylaxis
with different therapies for children’s acute lymphoblastic leukemia (ALL).
Methods: From 1991.1 to 2000.12, 429 patients with ALL
in our hospital, male 277 and female 152, had been observed for the effect
of sanctuary phylaxis. The median observation period was 43.9 months
(5.5~128 months). The induction protocol was CODLP. As complete remission
was achieved, the consolidation treatment was VM26 plus cytosine
arabinoside (Ara-c) and then infusing with HD-MTX 3g/m2, one
time per 10~14 days for 3 cycles in total. After the treatments above, the
patients were divided into two groups. GroupⅠ: Intrathecal injection
(ITI) of Ara-c, dexamethasone and MTX one time per 8 weeks. GroupⅡ: 18 Gy radiation for
sanctuary phylaxis 6 months later. All the patients were treated through
the end of chemotherapy. Of the 211 high-risk patients, 61 cases were in
GroupⅠ, 150 cases were in GroupⅡ.
Results: The morbidities of central nervous system
leukemia(CNSL) for all the patients, GroupⅠ, Group Ⅱ, high-risk groupⅠand high-risk groupⅡ were 2.56%(11/429),
2.12% (5 of 236), 3.10% (6 of 193), 3.27%(2/61) and 3.33%(5/150),
respectively. The morbidity of testicle leukemia (TL) was 2.53%(7 of 277).
Discussion: 1. HD-MTX could more effectively prevent
patients from CNSL & TL in contrast to 24 Gy radiation which was
commonly used in 1980’s and the morbidities of CNSL & TL were up to
7.81% and 7.4% respectively. 2. The effects of ITI and radiation are
similar (P>0.05) and we should control the patient number of radiation.
3. The effects of ITI and radiation in high-risk ALL are also similar
(P>0.05). It’s to be resolved whether cerebral cranium radiation is
necessary in high-risk ALL.