中华血液学杂志
中華血液學雜誌
중화혈액학잡지
Chinese Journal of Hematology
2015年
1期
10-15
,共6页
王婧%黄晓军%江滨%贾晋松%杨申淼%鲍立%江浩%路瑾%主鸿鹄
王婧%黃曉軍%江濱%賈晉鬆%楊申淼%鮑立%江浩%路瑾%主鴻鵠
왕청%황효군%강빈%가진송%양신묘%포립%강호%로근%주홍곡
白血病,淋巴样%中枢神经系统白血病%左旋门冬酰胺酶%造血干细胞移植
白血病,淋巴樣%中樞神經繫統白血病%左鏇門鼕酰胺酶%造血榦細胞移植
백혈병,림파양%중추신경계통백혈병%좌선문동선알매%조혈간세포이식
Leukaemia,lymphoid%Central nervous system leukaemia%L-asparaginnse%Hematopoietic stem cell transplantation
目的 分析影响成人Ph染色体阴性急性淋巴细胞白血病(Ph ALL)患者预后的因素.方法 回顾性分析1999年12月至2013年12月连续收治的18～65岁Ph-ALL患者353例,以CODP±左旋门冬酰胺酶(L-Asp)方案诱导化疗,采用CODP和大剂量甲氨蝶呤(MTX)交替或改良Hyper-CVAD方案巩固化疗,178例(50.4％)患者在巩固3～5个疗程后行异基因造血干细胞移植(allo-HSCT),172例(49.6％)患者继续接受巩固和维持化疗.存活患者中位随访时间39.9(2.0～171.0)个月.结果 3例(0.85％)患者早期死亡.350例可评估患者中,1个疗程完全缓解(CR) 271例(77.4％),总CR 325例(92.9％).WBC≥100.0×109/L(P=0.010)、肝/脾/淋巴结肿大(P=0.036)是影响患者总CR的独立预后因素.在325例CR患者中,117例(36.0％)复发,5年累积复发率(CIR)为43.2％,5年无病生存(DFS)率和总生存(OS)率分别为44.7％和45.6％.多因素分析显示:诊断时伴随中枢神经系统白血病(CNSL) (P值分别为0.004、0.002和＜0.001)、诱导治疗未加用L-Asp(P值分别为0.023、0.009、0.004)、4周诱导化疗后未达CR(P值分别为0.034、0.024、0.003)以及未进行allo-HSCT(P值均＜0.001)是影响患者复发、DFS及OS率的独立预后不良因素;诊断时高WBC(B-ALL≥30×109/L,T-ALL≥100×109/L)(P=0.044)是降低DFS率的独立因素.以影响CR患者DFS的四个预后因素(诊断时WBC、是否伴随CNSL、诱导治疗是否加用L-Asp及4周诱导化疗后是否达CR)将患者分为低危组(无不良因素)、中危组(1个不良因素)和高危组(至少2个不良因素).低危组非allo-HSCT和allo-HSCT患者DFS和OS差异无统计学意义,中、高危组中,相对于非allo-HSCT,allo-HSCT显著改善患者DFS和OS(P值均＜0.001).结论 对于成人Ph-ALL患者,诊断时WBC偏高(B-ALL≥30× 109/L,T-ALL≥100×109/L)、诊断时伴随CNSL、诱导治疗未加用L-Asp、诱导治疗4周未达CR及非allo-HSCT是独立影响预后的不良因素,具有前四项中一个或一个以上不良预后因素的患者,采用allo-HSCT更具生存优势.
目的 分析影響成人Ph染色體陰性急性淋巴細胞白血病(Ph ALL)患者預後的因素.方法 迴顧性分析1999年12月至2013年12月連續收治的18～65歲Ph-ALL患者353例,以CODP±左鏇門鼕酰胺酶(L-Asp)方案誘導化療,採用CODP和大劑量甲氨蝶呤(MTX)交替或改良Hyper-CVAD方案鞏固化療,178例(50.4％)患者在鞏固3～5箇療程後行異基因造血榦細胞移植(allo-HSCT),172例(49.6％)患者繼續接受鞏固和維持化療.存活患者中位隨訪時間39.9(2.0～171.0)箇月.結果 3例(0.85％)患者早期死亡.350例可評估患者中,1箇療程完全緩解(CR) 271例(77.4％),總CR 325例(92.9％).WBC≥100.0×109/L(P=0.010)、肝/脾/淋巴結腫大(P=0.036)是影響患者總CR的獨立預後因素.在325例CR患者中,117例(36.0％)複髮,5年纍積複髮率(CIR)為43.2％,5年無病生存(DFS)率和總生存(OS)率分彆為44.7％和45.6％.多因素分析顯示:診斷時伴隨中樞神經繫統白血病(CNSL) (P值分彆為0.004、0.002和＜0.001)、誘導治療未加用L-Asp(P值分彆為0.023、0.009、0.004)、4週誘導化療後未達CR(P值分彆為0.034、0.024、0.003)以及未進行allo-HSCT(P值均＜0.001)是影響患者複髮、DFS及OS率的獨立預後不良因素;診斷時高WBC(B-ALL≥30×109/L,T-ALL≥100×109/L)(P=0.044)是降低DFS率的獨立因素.以影響CR患者DFS的四箇預後因素(診斷時WBC、是否伴隨CNSL、誘導治療是否加用L-Asp及4週誘導化療後是否達CR)將患者分為低危組(無不良因素)、中危組(1箇不良因素)和高危組(至少2箇不良因素).低危組非allo-HSCT和allo-HSCT患者DFS和OS差異無統計學意義,中、高危組中,相對于非allo-HSCT,allo-HSCT顯著改善患者DFS和OS(P值均＜0.001).結論 對于成人Ph-ALL患者,診斷時WBC偏高(B-ALL≥30× 109/L,T-ALL≥100×109/L)、診斷時伴隨CNSL、誘導治療未加用L-Asp、誘導治療4週未達CR及非allo-HSCT是獨立影響預後的不良因素,具有前四項中一箇或一箇以上不良預後因素的患者,採用allo-HSCT更具生存優勢.
목적 분석영향성인Ph염색체음성급성림파세포백혈병(Ph ALL)환자예후적인소.방법 회고성분석1999년12월지2013년12월련속수치적18～65세Ph-ALL환자353례,이CODP±좌선문동선알매(L-Asp)방안유도화료,채용CODP화대제량갑안접령(MTX)교체혹개량Hyper-CVAD방안공고화료,178례(50.4％)환자재공고3～5개료정후행이기인조혈간세포이식(allo-HSCT),172례(49.6％)환자계속접수공고화유지화료.존활환자중위수방시간39.9(2.0～171.0)개월.결과 3례(0.85％)환자조기사망.350례가평고환자중,1개료정완전완해(CR) 271례(77.4％),총CR 325례(92.9％).WBC≥100.0×109/L(P=0.010)、간/비/림파결종대(P=0.036)시영향환자총CR적독립예후인소.재325례CR환자중,117례(36.0％)복발,5년루적복발솔(CIR)위43.2％,5년무병생존(DFS)솔화총생존(OS)솔분별위44.7％화45.6％.다인소분석현시:진단시반수중추신경계통백혈병(CNSL) (P치분별위0.004、0.002화＜0.001)、유도치료미가용L-Asp(P치분별위0.023、0.009、0.004)、4주유도화료후미체CR(P치분별위0.034、0.024、0.003)이급미진행allo-HSCT(P치균＜0.001)시영향환자복발、DFS급OS솔적독립예후불량인소;진단시고WBC(B-ALL≥30×109/L,T-ALL≥100×109/L)(P=0.044)시강저DFS솔적독립인소.이영향CR환자DFS적사개예후인소(진단시WBC、시부반수CNSL、유도치료시부가용L-Asp급4주유도화료후시부체CR)장환자분위저위조(무불량인소)、중위조(1개불량인소)화고위조(지소2개불량인소).저위조비allo-HSCT화allo-HSCT환자DFS화OS차이무통계학의의,중、고위조중,상대우비allo-HSCT,allo-HSCT현저개선환자DFS화OS(P치균＜0.001).결론 대우성인Ph-ALL환자,진단시WBC편고(B-ALL≥30× 109/L,T-ALL≥100×109/L)、진단시반수CNSL、유도치료미가용L-Asp、유도치료4주미체CR급비allo-HSCT시독립영향예후적불량인소,구유전사항중일개혹일개이상불량예후인소적환자,채용allo-HSCT경구생존우세.
Objective To analyze the prognostic factors in adult Philadelphia chromosome negative acute lymphoblastic leukaemia (Ph ALL).Methods From December 1999 to December 2013,353 consecutive hospitalized 18-65-year-old adult Ph-ALL patients were retrospectively analyzed.Induction therapy was CODP±L-asparaginase (L-Asp) regimen,and consolidation therapy included CODP and high dose methotrexate or revised Hyper-CVAD A and B regimens for 8 cycles.178 patients (50.4％) performed allo-HSCT after three to five cycles of consolidation treatment,and 172 patients didn't receive allo-HSCT.The median follow-up was 39.9 months (2.0 to 171.0 months) for the 184 survivors.Results Three patients (0.85％) happened early death.CR rate after the first cycle of induction chemotherapy was 77.4％ (271/350) among evaluated 350 patients.Overall CR rate was 92.9％ (325/350).WBC ≥100.0× 109/L (P=0.010) and hepatomegaly/splenomegaly/lymphadenopathy (P=0.036) were independent adverse factors for overall CR.Among the 325 CR patients,117 patients developed relapse,cumulative incidence of relapse (CIR) at 5 years was 43.2％,disease-free survival (DFS) and overall survival (OS) rates at 5 years were 44.7％ and 45.6％ respectively.Multivariate analysis showed that harboring central nervous system leukaemia (CNSL) at diagnose (P=0.004,P=0.002,P＜ 0.001,respectively),induction regimen without L-Asp (P=0.023,P=0.009,P=0.004,respectively),time to CR more than 4 weeks (P=0.034,P=0.024,P=0.003,respectively),and non-allo-HSCT (P ＜ 0.001,P ＜ 0.001,P ＜ 0.001,respectively) were adverse factors of relapse,DFS and OS.In addition,high WBC count at diagnosis (≥30.0 × 109/L for B lineage and ≥ 100.0× 109/L for T lineage) was poor factor of DFS (P=0.044).Based on the four adverse prognostic factors of DFS above mentioned (including WBC at diagnose,harboring CNSL at diagnose,induction regimen with or without L-Asp,time to CR more than 4 weeks),patients were grouped into low risk (no factor),intermediate risk (one factor),and high risk (at least two factors).Non-allo-HSCT and allo-HSCT had similar outcomes in low risk subgroup.Allo-HSCT significantly improved OS and DFS in intermediate and high risk subgroups rather than non-allo-HSCT (all P values ＜ 0.001).Conclusion In adult Ph-ALL patients,high WBC count at diagnosis (≥30.0 × 109/L for B lineage and ≥ 100.0 × 109/L for T lineage),CNSL at diagnosis,induction regimen without L-Asp,time to CR more than 4 weeks and non-allo-HSCT were adverse prognostic factors.Allo-HSCT improved OS and DFS in patients with more than one of the first four adverse prognosis factors.
