摘要
目的 探讨自体造血干细胞移植(AHSCT)治疗年轻成人Ph-急性淋巴细胞白血病(ALL)的疗效.方法 纳入56例于2000年1月至2007年12月接受BDHALL2000/02方案治疗并于CR1期行AHSCT的成人(15~60岁)Ph ALL患者,对其进行生存和预后影响因素分析.结果 56例患者中标危、中危和高危者分别为23例(41.1%)、19例(33.9%)和14例(25.0%).中位随访75(7~177)个月.5年总生存(0S)、无事件生存(EFS)、无复发生存(RFS)、复发率分别为(51.8±6.7)%、(51.8±6.7)%、(60.5±6.9)%、(39.1±6.9)%.标、中、高危组患者的5年OS率分别为(60.9±10.2)%、(52.6±11.5)%和(35.7±12.8)%,EFS率分别为(60.9± 10.2)%、(52.6±11.5)%和(35.7±12.8)%,RFS率分别为(68.3±9.9)%、(62.5± 12.1)%和(44.9± 14.1)%,复发率分别为(31.7±9.9)%、(37.5±12.1)%和(55.1±14.1)%.标危和中危组、中危和高危组患者的上述指标比较差异均无统计学意义(P值均>0.05);标危组患者的OS、EFS率高于高危组(P值分别为0.040和0.029),而RFS和复发率差异则无统计学意义(P值均>0.05).对年龄≥35岁、完全缓解时间超过5周、初诊白细胞水平、免疫表型(B/T)、伴髓系表达、超二倍体染色体核型、复杂核型、完全缓解至AHSCT间隔时间、预处理方案是否包含TBI等进行单因素分析,均未显示对预后存在影响(P值均>0.05).结论 年轻成人Ph-ALL患者经BDHALL2000/02方案治疗可以获得较高的缓解率,缓解后给予早期序贯强化/巩固治疗后进行AHSCT疗效显著,是标危、中危组及无合适供者的高危组患者的合适选择.
Objective To evaluate the results of autologous hematopoietic stem cell transplantation (auto-HSCT) in adults with Philadelphia chromosome-negative acute lymphoblastic leukemia (Ph-ALL).Methods From January 2000 to December 2007,the clinical data of auto-HSCT in adults Ph ALL with complete remession (CR) 1 according to BDHALL2000/02 protocol were analyzed.Results A total of 56 patients were enrolled and the probabilities of standard risk,intermediated risk and high-risk group were 41.1%,33.9%,and 25.0%,respectively.After a median follow-up of 75 months (range 7-177 months),the 5-year overall survival (OS),events free survival (EFS) and relapse free survival (RFS) were (51.8 ± 6.7)%,(51.8 ± 6.7)%,and (60.5 ± 6.9)%,respectively.And the 5-year accumulative relapse rate was (39.1±6.9)%.The 5-year OS of standard risk,intermediate risk,high-risk group were (60.9±10.2)%,(52.6±11.5)%,and (35.7±12.8)%,respectively.The 5-year RFS among three groups were (68.3±9.9)%,(62.5±12.1)%,and (44.9±14.1)%,respectively.The 5-year EFS among three groups were (60.9±10.2)%,(52.6± 11.5)%,and (35.7±12.8)%,respectively.The 5-year accumulative relapse rate among three groups were (31.7±9.9) %,(37.5 ±12.1) %,and (55.1±14.1) %,respectively.There was no statistical significance of any survival rates between standard and intermediate risk groups,just as intermediate and high-risk groups.The OS and EFS in standard risk group were superior to those in highrisk group (P=0.040 and P=0.029,respectively),while there was no statistical significance of RFS and accumulative relapse rate between the two groups.The clinical factors listed below did not influenced the prognosis in the univariate analysis (P>0.05),including more than 5 weeks reaching to CR,WBC count at diagnosis,different immunophenotype (T or B cells),myeloid antigen expression,hyperdiploid chromosome karyotype,complex chromosome abnormality,conditioning regimen with or without TBI,duration between transplantation and diagnosis.Conclusions Ph-ALL adults could achieve a satisfactory CR and better survial according to BDHALL2000/02 protocol followed by auto-HSCT,especially for the standard or intermediate risk group,and no-donors high-risk patients.
出处
《中华血液学杂志》
CAS
CSCD
北大核心
2015年第6期480-484,共5页
Chinese Journal of Hematology
基金
十二五国家科技支撑计划项目(2014BAI0912)
关键词
造血干细胞移植
白血病
淋巴样
费城染色体
成年人
Hematopoietic stem cell transplantation
Leukemia, lymphoid
Philadelphia chromosome
Adult