成人急性淋巴细胞白血病的化疗及预后因素分析

目的 分析成人急性淋巴细胞白血病(ALL)的临床特点,比较不同化疗方案组患者的疗效,探讨影响长期生存的因素.方法 回顾性分析1998年6月至2005年12月住院治疗的成人ALL患者149例.采用SPSS11.5统计软件分析有关数据.结果 ①133例患者进行了免疫表型分析,其中B细胞表型118例(88.7%),T细胞表型15例(11.3%).有染色体核型结果的患者105例,正常核型40例(38.1%),异常核型65例(61.9%).②按诱导治疗方案不同将治疗满4周的患者分为VDCP、VDLP、VDCLP三组,诱导治疗总完全缓解(CR)率为93.7%.三组患者诱导治疗1个疗程结束时CR率分别为80.8%、92.3%、81.4%,差异无统计学意义(P=0.618).包含和不包含门冬酰胺酶的诱导方案诱导治疗结束时CR率分别为95.5%和92.1%,差异无统计学意义(P=0.566).患者中位无病生存(DFS)期为12(1～74)个月,中位总生存(OS)期为17.5(1～97)个月.三组患者3年及5年DFS率分别为18.5%和14.8%、24.7%和9.9%、39.5%和39.5%,组间差异有统计学意义(P=0.0066).③通过COX回归模型分析显示患者就诊时年龄＞40岁、WBC＞40×109/L、染色体t(9;22)及巩固治疗不足4个疗程为预后不良因素.结论 成人ALL免疫表型检测以B-ALL为主,染色体核型变化较大.多数患者在接受4或5种药物联合的诱导方案治疗后可获CR;用门冬酰胺酶不影响诱导治疗CR率,但可提高患者的DFS和OS率.染色体核型异常影响患者生存情况.充分的巩固强化治疗对延长生存期必不可少.就诊时的年龄、白细胞计数、染色体核型检查结果及巩固治疗疗程数为影响生存的预后因素.

Analysis of chemotherapeutic results and prognostic factors of adult acute lymphoblastic leukemia

Objeetive To explore the clinical characteristics of aduh acute lymphoblastic leukemia (ALL),compare the efficacy of different induction regimens and analyze the prognostic factors.Methods Data of 149 aduh ALL patients hospitalized in our institute between June 1998 and December 2005 were retro spectively reviewed.The results were analyzed with the SPSS11.5 software.Results ①Out of 133 patients available immunophenotype data,118(88.7%)were B-ALL and 15(11.3%)T-ALL.Cytogenetic analysis was performed in 105 patients,40 cases(38.1%)of them had a normal karyotype and 65(61.9%)chromosome aberrations.②149 patients completed the VDCP,VDLP or VDCLP induction therapies(at least 4 weeks treatment for each),140(93.7%)of them achieved complete remission(CR)with the flint conrse CR rates of 80.8%,92.3%and 81.4%,respectively(P=0.618).CR rates in pafients after the induction regimens with or without asparaginase were 95.5%versus 92.1%(P=0.566).With a median follow-up of 14.5(1-75)months,the median diseage free survival(DFS)was 12(1-74)months and median overall survival(OS)17.5(1-97)months.DFS of the three regimen groups at 3 and 5 years were 18.5%and 14.8%,24.7%and 9.9%,39.5%and 39,5%,respectively(P=0.0066).③COX regression analysis showed that the age(over 40 years),white blood cell(WBC)count(＞40×109/L),t(9;22)(q34;q11)-positive and less than 4 courses consolidation chemotherapy were the unfavorable prognostic factors.Conclusions Most adult ALL patients are B-ALL and karyotype have more changed.More than 90%patients can achieve CR with induction regimens consisting of 4 or 5 drugs.Induction regimens containing L-asparaginasemay not affect the CR rate,but can improve DFS and OS.Age and WBC at diagnosis,presence of t(9;22)(q34;q11)and the courses of post-remission treatment are important prognostic factors.