摘要：

Background Patients with ataxia‐telangiectasia (A㏕) are at an increased risk for developing lymphoid malignancies, yet the appropriate therapy remains unknown. Radiation therapy at conventional doses results in destruction of normal tissue, which has suggested that fullヾose chemotherapy might result in unacceptable toxicity in A㏕ patients with cancer. Procedure The medical records of 412 A㏕ patients were reviewed to identify those patients who developed lymphoid malignancies and to analyze the type and duration of therapy, events during therapy, and off‐therapy follow;esults Of 74 A㏕ patients with lymphoid malignancies, 32 patients received chemotherapy. The 21 patients treated with standard chemotherapy had a significantly better median survival (9 months, range, 1–162+ months vs. 5 months, range, 0.5–28 months) (P= 0.03) and complete remission rate (76% vs. 9%) (P = 0.001) than the 11 treated with reduced dose chemotherapy. Three of the 21 fullヾose chemotherapy patients required dose reductions because of neutropenia. Seven of the 14 patients exposed to 1,200 mg/m or greater of cyclophosphamide developed hemorrhagic cystitis. All three patients exposed to bleomycin developed pulmonary disease which was fatal in two. Of the 16 standardヾose chemotherapy patients who achieved a complete remission, two remain disease‐free, five have died of recurrent disease, and five died of pulmonary disorders and four of other causes while in remission. Conclusions Standardヾose chemotherapy should be given to each A㏕ patient with a lymphoid malignancy unless additional physical or emotional problems make it unlikely that the patient will benefit. Morbidity and mortality may be reduced by prophylaxis against hemorrhagic cystitis and early detection and treatment of pulmonary disorders. Med. Pediatr. Oncol. 31:491–497, 1998. 1998 Wiley㎜iss, Inc.

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