费城染色体阴性急性淋巴细胞白血病诱导化疗2周后骨髓原始细胞比例及其对完全缓解和总体预后的影响

Ratio of Primary Bone Marrow Cells after Induction Chemothrapy for Two Weeks in the Patients with Ph^- ALL and Its Influence on Complete Remission and Overall Progrosis

目的:探讨费城染色体阴性急性淋巴细胞白血病(Ph^-ALL)诱导化疗2周后骨髓原始细胞比例及其对获得完全缓解和总体预后的影响。方法:选取本院于2012年3月至2016年2月期间收治的172例初治Ph^-ALL患者,对患者诱导化疗2周后的骨髓原始细胞比例进行受试者工作特性曲线(ROC)分析,同时确定其对获得完全缓解以及患者总体预后的影响。结果:患者达到完全缓解的界值为0.075,其曲线下面积为0.763,并且曲线下面积和A_z=0.5相比较,差异具有统计学意义。因此我院将172例患者按照其治疗2周后的骨髓原始细胞比例进行分组,其中骨髓原始细胞比例<0.075的患者有104例,占60.5%;而骨髓原始细胞比例≥0.075的患者则有68例,占39.5%。前者在诱导治疗4周后的获得CR的患者以及最终获得CR的患者分别为89(85.6%)和99(95.2%),显著高于后者的29(42.6%)和52(76.5%),2组患者数据比较差异具有统计学意义(P<0.05)。此外,临床上降低患者OS率和DFS率以及增加患者复发率的影响因素主要有化疗而非移植、诱导治疗4周后未能达到完全缓解、诱导治疗2周后骨髓原始细胞比例≥0.075以及诊断时伴随有中枢神经系统白血病等,而诊断时WBC升高则是影响患者DFS率的不利因素。结论:Ph^-ALL经诱导化疗2周后,骨髓原始细胞比例升高的患者将不利于获得完全缓解,并且总体预后较差。

Objective： To investigate the influence of bone marrow blasts ratio after induction chemotherapy for 2 weeks in patients with Ph- ALL, and it＇s influence on complete remission （CR） and overall prognosis. Methods： A total of 172 patients with Ph- ALL in our hospital from March 2012 to February 2016 were selected. The bone marrow blast ratio was analyzed by the receiver - operating characteristic curve （ROC） in patients after induction chemotherapy for 2 weeks, at same time its influence on CR and overall prognosis of Ph- ALL patients was evaluated. Results： The cutoff value of CR was 0. 075, its area under ROC was 0. 763 ; the comparison of area under ROC with Az = 0.5 showed statistically significant difference, therefore 172 patients with Ph- ALL were grouped according to bone marrow blast ratio after induction chemotherapy for 2 weeks： 104 cases （60. 5% ） with bone marrow blast ratio 〈 0. 075, 68 cases （39.5%） with bone marrow blast ratio t〉0. 075. The Ph- ALL patinets with bone marrow blast ratio 〈 0. 075 who achieved CR and finally achieved CR after induction chemotherapy for 4 weeks acconnted for 89 （ 85.6% ） and 99 （95.2%） respectively, which were significantly higher than those in Ph- ALL patients with bone marrow blast ratio 〉 0. 075,129 （42. 6% ） and 52 （76.5 % ） 1 （ P 〈 0.05 ）. In addition, the influencing factor clinically reducing the OS and DFS rate of patients and enhancing the ralapse rate of patients were mainly chemotherapy, the failure of induction chemotherapy （ patients did not achieve CR after induction therapy for 4 weeks）, the bone marrow blast ratio t〉 0. 075 after induction treatment for 2 weeks, and CNSL at diagnosis and so on. while the enhaced WBC count at diagnosis waspoor factor affecting the DFS rate of patients. Conclusion ： After induction chemotherapy for 2 weeks, the elevated bone marrow blast ratio in Ph- ALL patients will be infavourable to CR, and the overall prognosis is poor.