CAJ | 학술논문

目的比较传统成人Ph阴性急性淋巴细胞白血病(ALL)治疗方案和借鉴儿童ALL的新化疗方案在疗效及安全性上的差异,并进一步分析这两种化疗方案对不同年龄段患者疗效的差异.方法收集2009年1月4日至2013年9月4日收治的144例初治Ph阴性ALL患者资料,根据治疗方案分为传统的成人方案(方案1)组和借鉴儿童ALL的新化疗方案(方案2)组,分析其整体及不同分组条件下的疗效及安全性.结果 144例患者接受化疗后,总完全缓解(CR)率为95.8％,1个疗程CR率为92.4％,5年总生存(OS)率为59.0％,5年无复发生存(RFS)率为48.6％.其中方案1组和方案2组患者的CR率(95.6％和96.1％,P=0.783)、3年OS率(65.3％和63.4％,P=0.885)和3年RFS率(56.0％和50.0％,P=0.931)差异均无统计学意义.方案1组中,14～30岁患者的OS明显优于31～60岁患者(3年OS率69.6％对54.7％,P=0.042),RFS差异则无统计学意义(3年RFS率56.5％对57.0％,P=0.472);方案2组中,14～30岁患者与31～60岁患者在OS及RFS上差异均无统计学意义(3年OS率65.7％对60.3％,P=0.423;3年RFS率51.5％对46.6％,P=0.655).两组患者在呼吸衰竭、心功能不全、真菌感染及肠梗阻发生率上差异均无统计学意义,方案1组患者的肾功能不全发生率低于方案2组(P=0.011),菌血症发生率高于方案2组(P=0.000).结论 Ph阴性ALL患者对两套化疗方案耐受性均较好,具有较高的CR率及长期生存率;同时,高龄(31～60岁)患者有可能从非骨髓抑制药物含量高、化疗强度低的方案2中受益.
목적 비교전통성인Ph음성급성림파세포백혈병(ALL)치료방안화차감인동ALL적신화료방안재료효급안전성상적차이,병진일보분석저량충화료방안대불동년령단환자료효적차이.방법 수집2009년1월4일지2013년9월4일수치적144례초치Ph음성ALL환자자료,근거치료방안분위전통적성인방안(방안1)조화차감인동ALL적신화료방안(방안2)조,분석기정체급불동분조조건하적료효급안전성.결과 144례환자접수화료후,총완전완해(CR)솔위95.8％,1개료정CR솔위92.4％,5년총생존(OS)솔위59.0％,5년무복발생존(RFS)솔위48.6％.기중방안1조화방안2조환자적CR솔(95.6％화96.1％,P=0.783)、3년OS솔(65.3％화63.4％,P=0.885)화3년RFS솔(56.0％화50.0％,P=0.931)차이균무통계학의의.방안1조중,14～30세환자적OS명현우우31～60세환자(3년OS솔69.6％대54.7％,P=0.042),RFS차이칙무통계학의의(3년RFS솔56.5％대57.0％,P=0.472);방안2조중,14～30세환자여31～60세환자재OS급RFS상차이균무통계학의의(3년OS솔65.7％대60.3％,P=0.423;3년RFS솔51.5％대46.6％,P=0.655).량조환자재호흡쇠갈、심공능불전、진균감염급장경조발생솔상차이균무통계학의의,방안1조환자적신공능불전발생솔저우방안2조(P=0.011),균혈증발생솔고우방안2조(P=0.000).결론 Ph음성ALL환자대량투화료방안내수성균교호,구유교고적CR솔급장기생존솔;동시,고령(31～60세)환자유가능종비골수억제약물함량고、화료강도저적방안2중수익.
Objective To analyze the difference of safety and efficacy between the traditional and the pediatric inspired acute lymphoblastic leukemia (ALL) chemotherapy regimen,and to further observe whether patients in different age group will benefit from the two regimens.Methods Adult de novo Ph negative ALL patients in our hospital from Jan 4,2009 to Sep 4,2013 were involved in this study and divided into 2 groups according to treatment regimens,the traditional regimen (regimen 1) and modified pediatric regimen (regimen 2) groups,respectively.The safety and the efficacy of all patients and different regimen groups were evaluated statistically.Results All 144 patients received the induction therapy.The total complete remission (CR) rate was 95.8％,one course CR rate was 92.4％,and 5 year overall survival (OS) and progression free survival (RFS) were 59.0％ and 48.6％ respectively.The CR rate,3 year OS and 3 year RFS between the two different regimens were 95.6％ vs 96.1％ (P=0.783),65.3％ vs 63.4％ (P=0.885) and 56.0％ vs 50.0％ (P=0.931),respectively.Further analysis stratified with age was also performed.For the patients treated with regimen 1,the 3 year OS and RFS between the two different age groups (14-30 years and 31-60 years) was 69.6％ vs 54.7％ (P=0.042) and 56.5％ vs 57.0％ (P=0.472).For the patients treated with regimen 2,the 3 year OS and RFS between the two different age groups (14-30 years and 31-60 years) was 65.7％ vs 60.3％ (P=0.423) and 51.5％ vs 46.6％ (P=0.655).No differences were found on the respiratory failure,cardiac dysfunction,fungal infection and intestinal obstruction between the two treatment regimen groups.The incidence of renal dysfunction for regimen 1 was lower than that of regimen 2 (P=0.011).The incidence of bacteremia for regimen 1 was higher than that of regimen 2 (P=0.000).Conclusion The two treatment regimens for adult Ph negative ALL patients were well tolerated and showed relative favorable CR rate and long term survival rate.The older patients (31-60 years) tended to benefit from the regiment 2 which was less intensive and consisted of more agents with low suppression to bone marrow.