bcr-abl阳性急性淋巴细胞白血病分子生物学特点及预后分析

Molecular biological characteristics and prognosis analysis of bcr-abl positive acute lymphoblastic leukemia

目的探讨ber-abl阳性急性淋巴细胞白血病的分子生物学特点以及在目前治疗条件下的临床疗效和预后。方法回顾性分析2009年3月至2014年3月收治的35例初发ber-abl阳性急性淋巴细胞白血病患者资料，比较不同化疗方案、不同转录本及移植与非移植之间达到第一次完全缓解（CR，）时间、生存及复发的差异，评价临床疗效及预后。结果35例初发bet—abl阳性急性淋巴细胞白血病患者中，男性21例，女性14例，中位年龄38岁（16—65岁），白细胞计数中位水平29．5×109／L（1．33×109／L-192．45×109／L）。转录本p190阳性26例（74．28％），mRNA中位相对表达水平0．5824（0．1233—0．9760），p210阳性9例（25．72％），mRNA中位相对表达水平0．6235（0．0974～0．9592）。中位随访12个月。35例初发患者采用4种不同的诱导化疗方案联合伊马替尼进行治疗，四组不同化疗方案达到CR。时间差异无统计学意义（P=0．518）；转录本p190阳性组患者达到CR，时间较转录本p210阳性组患者延长（P=0．016），但两组总生存（P=0．167）及复发（P=0．164）均差异无统计学意义。16例患者化疗缓解后进行了异基因造血干细胞移植，移植组中位生存时间32个月（7。43个月），非移植组中位生存时间13个月（4～18个月）（P=0．017），但复发率差异无统计学意义（P=0．072）。结论在联合伊马替尼治疗条件下，不同诱导化疗方案对ber-abl阳性急性淋巴细胞白血病疗效及预后无明显影响，转录本p190阳性患者疗效较转录本p210阳性患者差，但总生存与复发率无差异；异基因造血干细胞移植明显延长了患者的生存时间。

Objective To investigate the molecular biological characteristics of bcr-abl positive acute lymphoblastic leukemia, and to evaluate clinical efficacy and prognosis. Methods 35 newly diagnosed patients with bcr-abl positive acute lymphoblastic leukemia from March 2009 to March 2014 were retrospectively analyzed. The clinical efficacy and prognosis were evaluated through comparing and analyzing the first complete remission （CRy） time, overall survival （OS） and relapse rate （RR） among different induction chemotherapy regimens, between the different gene transcripts as well as between transplantation and non- transplantation. Results 35 patients were treated with four different induction chemotherapy regimens combined with imatinib. There were 21 male cases and 14 female cases among 35 patients, and their median age was 38 years old （16-65 years old）. According to the gene transcript, the patients were divided into p190 positive group including 26 cases （74.28 %） with the median gene expression level 0.582 4 （0.123 3-0.976 0） and p210 positive group including 9 cases （25.72 %） with the median gene expression level 0.623 5 （0.097 4- 0.959 2）. Median follow-up time was 12 months, then CRl-reaching time of the four induction chemotherapy regimens was not different statistically （P = 0.518）. CRy-reaching time in p190 positive group was extended （P = 0.016）, and overall survival （P = 0.167） and the relapse rate （P = 0.164） were no differences compared with those in p210 positive group. Allogeneic hematopoietic stem cell transplantation was performed in 16 morphology CR patients after chemotherapy. The median survival time of transplantation group was 32 months （7-43 months）, and that of non-transplantation group was 13 months （4-18 months） （P = 0.017）, but their RR difference was no statistical significance （P = 0.072）. Conclusions The CRl-reaching time of bcr-abl positive acute lymphoblastic leukemia patients has no obvious difference in the four induction chemotherapy regimens combined with imatinib. The CRx-reaching time of patients with p190 positive is obviously prolonged compared with that with p210 positive, but the OS and RR have no significant difference. Allogeneic hematopoietic stem cell transplantation can improve the OS.