102例成人费城染色体阴性急性淋巴细胞白血病临床预后因素分析
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摘要
目的:分析成人费城染色体阴性(Ph)急性淋巴细胞白血病(ALL)患者的临床特征与疗效的关系。方法:收集102例成人Ph--ALL患者的临床资料,分析患者的临床和生物学特征与完全缓解率(CR)的关系,用COX多因素回归模型分析影响患者总生存时间和无疾病生存时间的相关因素。结果:102例初诊Ph--ALL患者中4周诱导化疗81例患者达CR,CR率79.41%,患者的发病年龄(P=0.022)、初诊时白细胞计数(P=0.003)、伴有肝脾/淋巴结肿大(P=0.034)、诱导化疗2周后骨髓原始细胞比例(P=0.003)是Ph--ALL患者CR率的影响因素。81例达CR的患者中位生存时间为12个月,5年总生存率为32.11%,5年无疾病生存率为27.96%,COX多因素分析发现发病年龄(P=0.010)、初诊时白细胞计数(P=0.040)、4周诱导化疗达CR(P=0.010)为影响成人Ph--ALL的独立预后因素。结论 :发病时年龄、初诊时白细胞计数、诱导化疗4周达CR是影响成人Ph--ALL患者的独立预后因素,积极接受异基因造血干细胞移植可以提高成人Ph--ALL患者的疗效。
Objective:To analyze the relationship between clinical characteristics and curative effect in adult patients with Philadelphia(Ph)chromosome negative acute lymphoblastic leukemia(ALL).Method:The clinical data of 102 patients with adult Ph--ALL were analyzed retrospectively.The relationship between clinical characteristics and curative effect was analyzed.The COX analysis was used to reveal the risk factors affecting the patients' overall survival and disease-free survival time.Result:Among 102 Ph--ALL patients,81 patients(79.41%)achieved complete remission(CR)after treatment.The age of onset(P=0.022),the number of white blood cells at initial diagnosis(P=0.003),the enlargement of lever spleen and lymphomode(P=0.034)and bone marrow blasts ratio after induction chemotherapy for 2 weeks(P=0.003)were the factors influencing the CR rate in patients with Ph--ALL.The median survival time of 81 patients with CR was 12 months,the overall survival rate in 5 years was32.11%and the disease-free survival rate in 5 years was 27.96%.COX multi-factor analysis showed that the age of onset(P=0.010),the number of white blood cells at the beginning of the initial diagnosis(P=0.040)and 4 weeks of induced chemotherapy amounted to CR(P=0.010)were independent prognostic factors affecting adult Ph--ALL patients.Conclusion:Age at the time of onset,the number of white blood cells at initial diagnosis and induction chemotherapy 4 weeks up CR are independent prognostic factors affecting adult Ph--ALL patients.Active acceptance of allogeneic hematopoietic stem cell transplantation can improve the curative effect of adult Ph--ALL patients.
Objective:To analyze the relationship between clinical characteristics and curative effect in adult patients with Philadelphia(Ph)chromosome negative acute lymphoblastic leukemia(ALL).Method:The clinical data of 102 patients with adult Ph--ALL were analyzed retrospectively.The relationship between clinical characteristics and curative effect was analyzed.The COX analysis was used to reveal the risk factors affecting the patients' overall survival and disease-free survival time.Result:Among 102 Ph--ALL patients,81 patients(79.41%)achieved complete remission(CR)after treatment.The age of onset(P=0.022),the number of white blood cells at initial diagnosis(P=0.003),the enlargement of lever spleen and lymphomode(P=0.034)and bone marrow blasts ratio after induction chemotherapy for 2 weeks(P=0.003)were the factors influencing the CR rate in patients with Ph--ALL.The median survival time of 81 patients with CR was 12 months,the overall survival rate in 5 years was32.11%and the disease-free survival rate in 5 years was 27.96%.COX multi-factor analysis showed that the age of onset(P=0.010),the number of white blood cells at the beginning of the initial diagnosis(P=0.040)and 4 weeks of induced chemotherapy amounted to CR(P=0.010)were independent prognostic factors affecting adult Ph--ALL patients.Conclusion:Age at the time of onset,the number of white blood cells at initial diagnosis and induction chemotherapy 4 weeks up CR are independent prognostic factors affecting adult Ph--ALL patients.Active acceptance of allogeneic hematopoietic stem cell transplantation can improve the curative effect of adult Ph--ALL patients.
引文
[1]Paul S,Kantarjian H,Jabbour EJ.Adult acute lymphoblastic leukemia[J].Mayo Clin Proc,2016,91:1645-1666.
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[6]邹德慧.《中国成人急性淋巴细胞白血病诊断与治疗的指南(2016版)》解读[J].临床血液学杂志,2017,30(9):680-682.
[7]Goldstone AH,Richards SM,Lazarus HM,et al.In adults with standard-risk acute lymphoblastic leukemia,the greatest benefit is achieved from a matched sibling allogeneic transplantation in first complete remission,and an autologous transplantation is less effective than conventional consolidation/maintenance chemotherapy in all patients:final results of the International ALL Trial(MRC UKALL XII/ECOGE2993)[J].Blood,2008,111:1827-1833.
[2]Catala M,Ocqueteau TM,Sarmiento MM.Acute lymphoblastic leukemia causing hepatic failure.Report of two cases[J].Rev Med Chil,2017,145:804-807.
[3]Sasaki K,Jabbour EJ,Ravandi F,et al.Hyper-CVADplus ponatinib versus hyper-CVAD plus dasatinib as frontline therapy for patients with Philadelphia chromosome-positive acute lymphoblastic leukemia:A propensity score analysis[J].Cancer,2016,122:3650-3656.
[4]Rowe JM,Buck G,Burnett AK,et al.Induction therapy for adults with acute lymphoblastic leukemia:results of more than 1 500patients from the international ALL trial:MRC UKALL XII/ECOG E2993[J].Blood,2005,106:3760-3767.
[5]Wermann WK,Gokbuget N.Acute lymphoblastic leukemia-diagnostics,subgroups and therapies[J].Dtsch Med Wochenschr,2018,143:1311-1317.
[6]邹德慧.《中国成人急性淋巴细胞白血病诊断与治疗的指南(2016版)》解读[J].临床血液学杂志,2017,30(9):680-682.
[7]Goldstone AH,Richards SM,Lazarus HM,et al.In adults with standard-risk acute lymphoblastic leukemia,the greatest benefit is achieved from a matched sibling allogeneic transplantation in first complete remission,and an autologous transplantation is less effective than conventional consolidation/maintenance chemotherapy in all patients:final results of the International ALL Trial(MRC UKALL XII/ECOGE2993)[J].Blood,2008,111:1827-1833.