シンポジウムII 造血器腫瘍の集学的治療
―その現況と問題点―
―その現況と問題点―
急性白血病の長期生存例
—第八次調査成績にもとずくその予後について—
1985 年 26 巻 6 号 p. 858-868
詳細
1985 年 26 巻 6 号 p. 858-868
As one of approaches for studying the curability of acute leukemia, we have bene investigating the clinical features of patients with acute leukemia for these 20 years who survived 5 years or longer after diagnosis of the disease. The data have resulted from the 862 patients with acute leukemia who were collected from main medical institutes throughout the country. There were 681 patients in children and 181 in adults, ranging from 0 year to 68 years of age. They included 261 in myeloblastic (ANLL), 593 in lymphoblastic (ALL) and 8 in unknown type. The predominant regimen for remission induction treatment was VCR+STH (VP) in children and DM+CA+6MP+STH (DCMP) in adults, respectively. In 57 patients who attained a CR with a single agent, their leukemic cells may have been remarkably sensitive to antileukemic agents.
The primary sites of leukemic relapse in adults were mostly in the bone marrow (95%), whereas those in children were not only in the marrow (39%), but also in the CNS (35.6%) and in the testis/ovary (16.5%).
With regard to prognosis of long-term survivors, the survival curves analysed by Kaplan-Meier's methods demonstrated that the longer the duration of maintenance treatment, the better the prognosis. The patients who had been treated for at least 5 years had a significantly longer survival than those who had been treated for less than 5 years. CNS prophylaxis was not likely to affect the prevention of CNS leukemia relapse, but contributed to prolongation of survival in patietns who received CNS prophylaxis.
Thus, when conventional maintenance therapy is utilized, there is no evidence at present of leukemic cure, but an initial 5 years maintenance treatment appears to be an important step for leukemic cure.
