早期白血病细胞清除与成人急性淋巴细胞白血病

Early Leukemic Blast Clearance in Adult Acute Lymphoblastic Leukemia

目的探讨早期白血病细胞清除在成人急性淋巴细胞白血病中的临床意义。方法45例成人急性淋巴细胞白血病患者以长春新碱、柔红霉素、环磷酰胺、泼尼松及左旋门冬酰胺酶方案诱导化疗，评估第15～21天期间骨髓白血病细胞比例，以白血病细胞占骨髓有核细胞5％以下作为早期白血病细胞清除标准，统计分析早期白血病细胞清除与成人急性淋巴细胞白血病临床结局的关系。结果病例随访时间1～61个月，中位随访时间9个月。获得早期白血病细胞清除的病例占总数的57．8％，与性别无关（P=1.0），但年龄大不利于早期白血病细胞清除（P=0．0419）。化疗后早期骨髓抑制有利于早期白血病细胞清除（P=0．018）。早期白血病细胞清除与4周内完全缓解密切相关（P=0．000）。未获早期白血病细胞清除者，几乎不可能达4周内完全缓解，这些病例4周以后获完全缓解的比例也不高（52．7％）。早期白血病细胞清除组的总生存时间长于对照组（P=0．0076）。但早期白血病细胞清除者的完全缓解持续时间、复发率、无病生存率、总生存率（1、2年）与未获早期白血病细胞清除者均无显著差异（P〉0．05）。结论早期白血病细胞清除是成人急性淋巴细胞白血病又一个有利的预后指标。

Objective To explore the clinical significance of early leukemic blast clearance （EI.BC） in adult acute lymphoblastic leukemia（ALL）. Methods Forty five adult patients with ALL were induced by VDCP（-L） protocol. Bone marrow aspirations were conducted between day 15 and 21 after initiation of the chemotherapy. Less than ,5 percent of the leukemic blasts among bone marrow nucleated cells were defined as ELBC. The relations between ELBC and clinical outcomes were analyzed statistically. Results Median follow-up was ,9 months（range 1-61 months）. 57.8% of the adult cases with ALL achieved ELBC which was not related to gender. Older patients were more difficult to get ELBC than the youngers （P=0. 041 9）. Early bone marrow suppression caused by chemotherapy would contribute to ELBC（P=0. 018）. Patients with ELBC were easier to get complete remission during 4 weeks （P=0. 000）. Patients without ELBC could hardly achieve complete remission during 4 weeks,and only 52.7 percent of them could experience complete remissions finally. Overall survival time in cases with ELBC was longer than that without ELBC（P=0. 0076）. But the duration of complete remission, relapse rate, disease-free survival rate, and overall survival rate were not different significantly between the two groups（P）0.05）. Conclusion ELBC is another favorable prognostic factor for adult patients with ALL .