CALLG2008方案治疗成人急性淋巴细胞白血病的单中心疗效分析

Efficacy of CALLG2008 Protocol in Treatment of Adult Acute Lymphoblastic Leukemia: A Single Center Analysis

本研究探讨根据危险因素分层,按照中国成人急性淋巴细胞白血病协作组制定的成人ALL序贯化疗整体方案——CALLG2008方案综合治疗成人ALL的疗效。按照方案的纳入和排除标准收集2009年5月1日至2011年12月31日间就诊于福建医科大学附属协和医院、应用CALLG2008方案治疗、年龄≥14岁的ALL患者的病例资料并进行疗效分析。结果表明,33例ALL患者中31例获得完全缓解(CR),CR率为93.9%,PR率为3.1%,总有效率97%,且血液学及非血液学毒副反应均能得到良好控制,无早期死亡病例,但1年总生存率仅66.7%,1年死亡率为33.3%,复发率43.8%,可能与部分患者治疗依从性不高、因经济原因中断治疗及病例数偏少、随访时间不长等有关。危险因素分析显示,初诊时WBC水平对ALL患者的OS、RFS有影响。结论:CALLG2008方案治疗成人ALL有着较高的诱导缓解质量,诱导期间死亡率不高,但对患者的长期无病生存情况有待进一步随访结果。坚持序贯治疗,开展MRD监测以判断早期复发及进行干预对巩固和提高长期疗效十分必要。

CALLG2008 Protocol is sequential chemotherapy for adult acute lymphoblastic leukemia（ALL） established by Collaborative Group of adults acute lymphoblastic leukemia.It is emphasized that comprehensive treatment of adult ALL according to risk stratification is rather important.This study was purposed to evaluate the therapeutic efficacy of CALLG2008 for adult ALL.The clinical data of adult ALL patients of ≥14 years old diagnosed and treated by CALLG2008 Protocol were collected from May 1,2009 to December 31,2011 in Fujian Medical University Union Hospital,and the efficacy was analyzed.The results showed that 31 out of 33 cases of ALL achived CR,the CR rate was up to 93.9%,the PR rate was 3.1%,and the total response rate was 97%.There were no uncontrolled severe toxicities,and no early deaths were observed.The overall survival（OS） at 1 year was only 66.7%,the relapse rate was 43.8% and the 1-year mortality was 33.3 %.This may be related with no-enough compliance,no-enough economical support and short follow-up time of the patients.The risk factor analysis showed that WBC level in newly diagnosed patients may influence the OS and relapse-free survival（RFS） of ALL.It is concluded that CALLG2008 protocol applied to adult ALL has a high remission quality and low mortality rate during the induction.The disease free survival（DFS） needs to be observed longer.It is essential to carry out MRD monitoring to determine the early recurrence and improving the long-term efficacy.