CAJ | 학술논문

目的分析北京大学人民医院14年间连续收治的成人急性淋巴细胞白血病(ALL)患者2006年前后的疗效差异.方法回顾性分析北京大学人民医院2000年1月至2013年12月连续收治的成人ALL患者477例,其中Ph染色体阴性B细胞ALL(Ph--B-ALL)276例(57.9％),T-ALL 69例(14.5％),Ph染色体阳性ALL (Ph+-ALL) 132例(27.7％);2006年之前收治111例(23.3％),2006年之后(含2006年)收治366例(76.7％).获得完全缓解(CR)患者中,持续化疗187例(43.0％),接受异基因造血干细胞移植(allo-HSCT)患者248例(57.0％).结果全部患者中位随访19个月,存活患者中位随访35个月,总CR率为92.0％,435例CR患者5年累积复发、无病生存(DFS)和总体生存(OS)率分别为42.5％、46.2％和47.6％.2006年之后与2006年之前相比:①Ph--B-ALL、T-ALL患者总CR率差异无统计学意义,Ph+-ALL患者总CR率显著增高(P=0.036);②全部CR患者5年DFS率(P=0.001)及OS率(P＜0.001)显著增高,其中Ph--B-ALL患者5年OS率显著增高(P=0.046),T-ALL (P=0.013和P=0.036)和Ph+-ALL(P=0.003和P＜0.001)患者5年DFS率和OS率均显著增高,尤其是诱导期加用伊马替尼的Ph+-ALL患者(P＜ 0.001和P＜0.001);③allo-HSCT患者5年DFS率(P=0.001)及OS率(P＜ 0.001)显著增高,而未行移植患者差异无统计学意义.2006年之后,诱导期加用伊马替尼的Ph+-ALL患者5年DFS、OS率显著高于Ph--B-ALL和T-ALL患者(P=0.009和P=0.001).多因素分析显示,接受allo-HSCT和诱导期伊马替尼联合化疗是改善ALL患者预后的2个重要因素.结论在过去的14年间以2006年为界,ALL患者的治疗结果明显改善,尤以Ph+-ALL患者为著.
목적 분석북경대학인민의원14년간련속수치적성인급성림파세포백혈병(ALL)환자2006년전후적료효차이.방법 회고성분석북경대학인민의원2000년1월지2013년12월련속수치적성인ALL환자477례,기중Ph염색체음성B세포ALL(Ph--B-ALL)276례(57.9％),T-ALL 69례(14.5％),Ph염색체양성ALL (Ph+-ALL) 132례(27.7％);2006년지전수치111례(23.3％),2006년지후(함2006년)수치366례(76.7％).획득완전완해(CR)환자중,지속화료187례(43.0％),접수이기인조혈간세포이식(allo-HSCT)환자248례(57.0％).결과 전부환자중위수방19개월,존활환자중위수방35개월,총CR솔위92.0％,435례CR환자5년루적복발、무병생존(DFS)화총체생존(OS)솔분별위42.5％、46.2％화47.6％.2006년지후여2006년지전상비:①Ph--B-ALL、T-ALL환자총CR솔차이무통계학의의,Ph+-ALL환자총CR솔현저증고(P=0.036);②전부CR환자5년DFS솔(P=0.001)급OS솔(P＜0.001)현저증고,기중Ph--B-ALL환자5년OS솔현저증고(P=0.046),T-ALL (P=0.013화P=0.036)화Ph+-ALL(P=0.003화P＜0.001)환자5년DFS솔화OS솔균현저증고,우기시유도기가용이마체니적Ph+-ALL환자(P＜ 0.001화P＜0.001);③allo-HSCT환자5년DFS솔(P=0.001)급OS솔(P＜ 0.001)현저증고,이미행이식환자차이무통계학의의.2006년지후,유도기가용이마체니적Ph+-ALL환자5년DFS、OS솔현저고우Ph--B-ALL화T-ALL환자(P=0.009화P=0.001).다인소분석현시,접수allo-HSCT화유도기이마체니연합화료시개선ALL환자예후적2개중요인소.결론 재과거적14년간이2006년위계,ALL환자적치료결과명현개선,우이Ph+-ALL환자위저.
Objective To compare the outcomes of patients with adult acute lymphoblastic leukemia (ALL) over the last 14 years by taking 2006 as the demarcation point.Methods From January 2000 to December 2013,477 consecutive hospitalized patients with adult ALL were retrospectively analyzed,including 276 (57.9％) with Ph negative B-ALL (Ph--B-ALL) B-ALL,69 (14.5％) with T-ALL and 132 (27.7％) with Ph positive ALL (Ph+-ALL);111 (23.3％) before 2006 and 366 (76.7％) after 2006.Among 435 patients who achieved complete remission (CR),248 (57.0％) received allogeneic hematopoietic stem cell transplantation (allo-HSCT),and 187 remained on chemotherapy.Results With a median follow-up period of 19 months in all patients and 35 months in living patients,overall CR rate was 92.0％.Of 435 CR patients,the cumulative incidences of 5-year relapse,disease-free survival (DFS) and overall survival (OS) rates were 42.5％,46.2％ and 47.6％,respectively.Compared with the patients hospitalized before 2006:① the Ph+-ALL patients hospitalized after 2006 achieved a higher overall CR rate (P=0.036).There was no difference for CR rates of Ph--B-ALL and T-ALL patients between before and after 2006.②The CR patients hospitalized after 2006 had higher 5-year DFS and OS rates (P=0.001;P ＜0.001),including higher 5-year OS rate in Ph--B-ALL patients (P=0.046),and higher 5-year DFS and OS rates in both T-ALL (P=0.013;P=0.036) and Ph+-ALL patients (P=0.003;P ＜ 0.001),especially in those Ph+-ALL patients who received imatinib from the beginning of the induction chemotherapy (P ＜ 0.001;P ＜0.001).③The patients who received allo-HSCT after 2006 had higher 5-year DFS and OS rates (P=0.001;P ＜ 0.001),but there was no difference for the outcomes in those who remained on chemotherapy before and after 2006.After 2006,Ph+-ALL patients who received imatinib from the beginning of the induction chemotherapy had the highest 5-year DFS and OS rates compared with Ph--B-ALL and T-ALL patients (P=0.009;P=0.001).Multivariate analysis showed that allo-HSCT and imatinib were two important factors affecting the outcomes of ALL patients.Conclusions The outcomes of ALL patients improved significantly over the last 14 years,especially in Ph+-ALL ones.