CAJ | 학술논문

目的评估伊马替尼联合化疗治疗Ph染色体阳性急性淋巴细胞白血病(Ph+ALL)的分子生物学疗效,并对预后因素进行分析.方法 2006年5月至2012年7月连续收治的Ph+ALL患者82例,在化疗的第1个疗程期加入伊马替尼治疗者48例；第2个疗程或之后加入伊马替尼治疗者34例.49例患者在巩固3～5个疗程后行异基因造血干细胞移植(allo-HSCT).在每个疗程结束后用实时定量PCR法检测BCR-ABL mRNA表达水平用以评估分子生物学疗效.结果 82例Ph+ALL患者总完全缓解(CR)率为92.7％(82例中76例),其中第1疗程化疗CR率为76.8％(82例中63例).第1疗程化疗时联合伊马替尼治疗者与未加伊马替尼者相比,CR率显著提高(93.8％对52.9％,P＜0.001).在第1疗程诱导化疗后BCR-ABL mRNA下降≥1个对数级的患者占55.3％.在获得CR的患者中,累计复发率为27.6％；3年无疾病复发生存(DFS)率及3年总生存(OS)率分别为60.5％及70.2％.allo-HSCT是降低复发的独立预后因素(P＜0.001).allo-HSCT、第1疗程诱导化疗时联合伊马替尼及女性是改善DFS的独立预后因素(P值分别＜0.01、0.05和0.01).第1疗程诱导化疗后BCR-ABL mRNA下降≥1个对数级及allo-HSCT是改善OS的独立预后因素(P值分别为0.011和0.027).结论第1疗程诱导化疗时联合伊马替尼、第1疗程诱导化疗后BCR-ABL mRNA下降≥1个对数级、接受allo-HSCT可以改善Ph+ALL患者预后.
목적 평고이마체니연합화료치료Ph염색체양성급성림파세포백혈병(Ph+ALL)적분자생물학료효,병대예후인소진행분석.방법 2006년5월지2012년7월련속수치적Ph+ALL환자82례,재화료적제1개료정기가입이마체니치료자48례；제2개료정혹지후가입이마체니치료자34례.49례환자재공고3～5개료정후행이기인조혈간세포이식(allo-HSCT).재매개료정결속후용실시정량PCR법검측BCR-ABL mRNA표체수평용이평고분자생물학료효.결과 82례Ph+ALL환자총완전완해(CR)솔위92.7％(82례중76례),기중제1료정화료CR솔위76.8％(82례중63례).제1료정화료시연합이마체니치료자여미가이마체니자상비,CR솔현저제고(93.8％대52.9％,P＜0.001).재제1료정유도화료후BCR-ABL mRNA하강≥1개대수급적환자점55.3％.재획득CR적환자중,루계복발솔위27.6％；3년무질병복발생존(DFS)솔급3년총생존(OS)솔분별위60.5％급70.2％.allo-HSCT시강저복발적독립예후인소(P＜0.001).allo-HSCT、제1료정유도화료시연합이마체니급녀성시개선DFS적독립예후인소(P치분별＜0.01、0.05화0.01).제1료정유도화료후BCR-ABL mRNA하강≥1개대수급급allo-HSCT시개선OS적독립예후인소(P치분별위0.011화0.027).결론 제1료정유도화료시연합이마체니、제1료정유도화료후BCR-ABL mRNA하강≥1개대수급、접수allo-HSCT가이개선Ph+ALL환자예후.
Objective To evaluate the molecular response and prognostic factors of patients with Philadelphia chromosome/BCR-ABL-positive acute lymphoblastic leukaemia (Ph + ALL) treated by imatinib with chemotherapy.Methods From May 2006 to July 2012,82 adult Ph+ ALL patients were enrolled in the study.Forty-eight patients combined imatinib in,and 34 patients after induction therapy.Forty-nine patients underwent allogeneic hematopoietic stem cell transplant (allo-HSCT) after 3 to 5 cycles of consolidation therapy.The molecular response of BCR-ABL mRNA was evaluated by real-time quantitative PCR in every chemotherapy course ending.Results The complete remission (CR) rate after the first cycle of induction chemotherapy was 76.8％ (63/82),with overall CR rate of 92.7％ (76/82).The CR rate in the patients combined imatinib in was higher than of those combined imatinib after the first cycle of induction chemotherapy (93.8％ vs 52.9％,P＜0.001).55.3％ patients BCR-ABL decreased ＞1 log after induction therapy.Among 76 CR patients,cumulative incidence of relapse was 27.6％,the probabilities of disease-free survival (DFS) and overall survival (OS) at 3 years were 60.5％ and 70.2％,respectively,allo-HSCT was an independent favorable factor for decrease of leukemia relapse (P＜0.001).allo-HSCT,imatinib combined in the first cycle of induction therapy and female were independent favorable factors for DFS (P＜ 0.01,0.05 and 0.01,respectively),BCR-ABL mRNA reduction at least 1 log from baseline after the first induction therapy and allo-HSCT were independent favorable factors for OS (P=0.011 and 0.027,respectively).Conclusion Imatinib combined in the first cycle of induction therapy,BCR-ABL mRNA reduction at least 1 log from baseline after the first induction therapy and allo-HSCT improved outcomes of Ph+ ALL patients.