成人Ph^-急性淋巴细胞白血病诱导治疗第14天骨髓原始细胞比例的预后意义

The prognostic significance of proportion of blasts in bone marrow on day 14 during induction chemotherapy in patients with adult Ph-negative acute lymphoblastic leukemia

目的探讨成人Ph染色体阴性急性淋巴细胞白血病（Ph—ALL）诱导治疗第14天（D14）骨髓原始细胞比例与获得完全缓解（cR）和预后的关系。方法回顾分析166例初治Ph—ALL患者，通过ROC曲线确定影响诱导治疗4周达CR的D14骨髓原始细胞比例。结果166例Ph_ALL患者，男94例，女72例，中位年龄32（18～64）岁。诱导治疗4周CR率为74．7％，总CR率为93．3％。存活者中位随访32（2-175）个月，5年无病生存（DFS）和总体生存（Os）率分别为45．6％和47．2％。D14骨髓原始细胞t〉0．075组与〈0．075组相比，4周CR率（42．7％对85．9％，P〈0．001）和总CR率（75．9％对95．6％，P=-0．001）显著降低，5年DFS率（29．6％对49．8％，P=-0．006）和OS率（32．6％对52．4％，P=0．010）均显著降低。多因素分析显示，发病时高白细胞计数、存在中枢神经系统白血病、D14骨髓原始细胞I〉0．075、诱导治疗4周未达CR、CR后接受化疗而非移植是影响DFS和OS的不利因素。结论成人PlrALL患者诱导化疗D14骨髓原始细胞比例较高是影响获得CR和总体预后的不利因素。

Objective To investigate the prognostic significance of proportion of the blasts in bone marrow on day 14 （D14） during induction chemotherapy in patients with adult Ph-negative acute lymphoblastic leukemia （Pff ALL）. Methods Newly diagnosed Ph- ALL patients with bone marrow morphology analysis on day 14 during induction chemotherapy were analyzed retrospectively. The proportion of the D14 blasts which had an impact on achieving a CR by the first induction chemotherapy and outcomes were determined by ROC curve. Results 166 ALL patients including 94 male and 72 female were analyzed. The median age was 32 years （range, 18-64 years）. The CR rate by the first induction chemotherapy was 74.7% with a total CR rate as 93.3%. By ROC analysis, 7.5% of the D14 blasts had the best sensitivity and specificity. The patients with D14 blasts≥7.5% had lower CR rates after the first and overall induction chemotherapy compared with those with D14 blasts 〈7.5% （42.7% vs 85.9%, P〈0.001 and 75.9% vs 95.6%, P=0.001 respectively）. The probabilities of 5-year disease free survival （DFS） and 5-year overall survival （OS） were higher in the patients with D14 blasts〈7.5% than those with D14 blasts/〉7.5% （49.8% vs 29.6%, .P=0.006 and 52.4% vs 32.6%, P=0.010 respectively）. Multivariate analysis showed that higher WBC or central nervous system leukemia at diagnosis, D14 blasts ≥7.5%, no CR after the first induction chemotherapy and receiving consolidation and maintenance chemotherapy rather than transplant were associated with poor outcomes. Conclusions Higher proportion of D14 blasts in bone marrow during the first induction therapy indicated poor prognosis in adult Ph- ALL.