CAJ | 학술논문

目的探讨Ph染色体阴性成人急性淋巴细胞白血病(Ph aALL)的系统序贯治疗方案(同济96方案)的疗效.方法回顾性分析2004年1月至2012年12月收治的95例初治Ph aALL患者的临床资料,并随访生存期.结果 95例Ph aALL患者总的完全缓解(CR)率为92.6％,7年总体生存(OS)率为(39.3±5.9)％,7年无事件生存(EFS)率为(31.5±5.3)％,中位生存期28个月;多因素COX比例风险回归模型分析,预后差核型组患者的死亡风险是预后良好组的3.380倍(95％ CI l.530～7.463,P=0.003),≥2个疗程获得CR者是单疗程获得CR者的3.005倍(95％ CI l.522～5.933,P=0.002);Kaplan-Meier法及Log-rank检验分析,＜60岁患者的7年OS率和EFS率明显高于≥60岁患者;单疗程获得CR者的7年OS率和EFS率明显高于≥2个疗程获得CR者;正常核型组和超二倍体核型组患者的2年OS率和EFS率明显高于复杂核型组、t(4;ll)组和其他核型组.结论年龄(60岁为界点)、获得CR的疗程数和细胞遗传学成为影响Ph-aALL患者生存的相关因素.同济96方案系统序贯治疗Ph-aALL,CR率达到发达国家水平,远期疗效令人满意,可以实现部分Ph-aALL患者的长期生存,减少其复发,改善预后.
목적 탐토Ph염색체음성성인급성림파세포백혈병(Ph aALL)적계통서관치료방안(동제96방안)적료효.방법 회고성분석2004년1월지2012년12월수치적95례초치Ph aALL환자적림상자료,병수방생존기.결과 95례Ph aALL환자총적완전완해(CR)솔위92.6％,7년총체생존(OS)솔위(39.3±5.9)％,7년무사건생존(EFS)솔위(31.5±5.3)％,중위생존기28개월;다인소COX비례풍험회귀모형분석,예후차핵형조환자적사망풍험시예후량호조적3.380배(95％ CI l.530～7.463,P=0.003),≥2개료정획득CR자시단료정획득CR자적3.005배(95％ CI l.522～5.933,P=0.002);Kaplan-Meier법급Log-rank검험분석,＜60세환자적7년OS솔화EFS솔명현고우≥60세환자;단료정획득CR자적7년OS솔화EFS솔명현고우≥2개료정획득CR자;정상핵형조화초이배체핵형조환자적2년OS솔화EFS솔명현고우복잡핵형조、t(4;ll)조화기타핵형조.결론 년령(60세위계점)、획득CR적료정수화세포유전학성위영향Ph-aALL환자생존적상관인소.동제96방안계통서관치료Ph-aALL,CR솔체도발체국가수평,원기료효령인만의,가이실현부분Ph-aALL환자적장기생존,감소기복발,개선예후.
Objective To investigate the efficacy and side effects of the consecutive chemotherapeutic protocol,Tongji-96,for adult patients with Philadelphia chromosome negative acute lymphoblastic leukemia (Ph-aALL).Methods A retrospective analysis was conducted on 95 cases of Ph aALL patients treated between January 2004 and December 2012 with Tongji-96 regimen in Tongji hospital,Shanghai.Results Among these 95 patients,the overall complete remission (CR) rate was 92.6％,7-year overall survival (OS) and event-free survival (EFS) rates were (39.3±5.9)％ and (31.5± 5.3)％,respectively,with the median survival of 28 months.Based on multivariable COX proportional hazards regression model analysis,patients with the poor karyotype and failed to achieve CR after first course induction therapy had a higher risk of mortality compared to those who had good or normal cytogenetics and achieved CR after 1 course of induction treatment [the risk ratios (RR) were 3.380 (95％ CI 1.530-7.463,P=0.003) and 3.005 (95％ CI 1.522-5.933,P=0.002),respectively].By means of Kaplan-Meier analysis and Log-rank test,patients aged less than 60 years and successively achieved CR after first induction therapy had more favorable 7-year OS and EFS rates.Patients with normal karyotype and hyperdiploidy had significantly higher 2-year OS and EFS rates compared with those with complex karyotype,t (4;11) translocation and other karyotypes.Conclusion Age (60 years as the cut-off),treatment courses for achieving CR and cytogenetics were predictive factors for the prognosis of Ph aALL from this retrospective study.As a comprehensive and sequential therapy protocol,Tongji-96 regimen was proved to obtain long-term survival,reduce risks for relapse and improve outcomes for part Ph aALL patients.