1例Ph染色体阳性成人急性淋巴细胞白血病的治疗

Treatment of Philadelphia Chromosome-Positive Acute Lymphoblastic Leukemia in an Adult

目的检索关于Ph染色体阳性成人急性淋巴细胞白血病(Ph+aALL)治疗的文献,以指导临床实践。方法计算机检索MEDLINE(1970～2005.7)和SUMSEARCH(截止2005.7)关于Ph+aALL治疗的系统评价、随机对照试验和临床对照试验。结果未检索到系统评价,检索到1篇随机对照试验和8篇临床对照研究。结果显示,Ph+aALL预后极差,化疗和骨髓移植是治疗此病的两种主要手段;常规化疗效果差,格列卫联合hyperCVAD的化疗方案有一定的优越性,但骨髓移植仍是目前可望治愈本病的唯一方法。结论格列卫联合hyperCVAD的化疗方案可提高Ph+aALL的缓解率和无病生存率,但骨髓移植仍是治疗此病的最佳选择。

Objective To search evidence in the treatment of Philadelphia chromosome （Ph）-positive acute lymphocytic leukemia （ALL） for guiding chnical practice. Methods We searched MEDLINE （ February, 1970～July, 2005 ） and SUMSEAILCH （till July, 2005 ）to identify systematic reviews（SIL）, randomized controlled trials（RCTs） and controlled clinical trials （CCTs） in the treatment of Ph-positive ALL. Results One RCT and 8 CCTs were identified. The results showed that Ph-positive ALL had a very poor prognosis . Chemotherapy and bone marrow transplantation （BMT） were the two main ways to treat the disease. Outcome of conventional chemotherapy treatment for adults with the disease was poor. Outcome of treatment with hyper-CVAD and imatinib mesylate was better and BMT was the only way which could potentially cure the disease. Conclusions Treatment of Ph-positive ALL with hyper-CVAD and imatinib mesylate may induce higher remission rate and disease free survival rate. BMT is the best way to cure the disease.