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IR@PKUHSC  > 北京大学第二临床医学院  > 北京大学血液病研究所  > 期刊论文
学科主题: 血液病
题名:
成人Ph染色体阴性急性淋巴细胞白血病患者预后因素分析
其他题名: Prognostic factors of adult Philadelphia chromosome negative acute lymphoblastic leukemia
作者: 王婧; 黄晓军; 江滨; 贾晋松; 杨申淼; 鲍立; 江浩; 路瑾; 主鸿鹄
关键词: 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 ; Leukaemia,lymphoid ; Central nervous system leukaemia ; L-asparaginnse ; Hematopoietic stem cell transplantation
刊名: 中华血液学杂志
发表日期: 2015
DOI: 10.3760/cma.j.issn.0253-2727.2015.01.003
卷: 36, 期:1, 页:10-15
收录类别: 中国科技核心期刊 ; 中文核心期刊 ; CSCD
文章类型: Journal Article
摘要: 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. 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.
语种: 中文
原文出处: 查看原文
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内容类型: 期刊论文
URI标识: http://ir.bjmu.edu.cn/handle/400002259/21103
Appears in Collections:北京大学第二临床医学院_北京大学血液病研究所_期刊论文

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作者单位: 100044,北京大学人民医院、北京大学血液病研究所
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