以VICP+L-ASP/TKI为诱导方案治疗成人急性B淋巴细胞白血病的疗效分析

Therapeutic Efficacy of VICP + L- ASP/TKI on Adult Patients with B-ALL

目的：评价以VICP＋L-ASP/TKI为诱导方案治疗成人急性B淋巴细胞白血病（B-ALL）的疗效并探讨其影响因素。方法：对2008年8月至2014年6月期间41例成人B-ALL患者进行了随访,观察接受VICP＋LASP/TKI方案诱导治疗后的完全缓解率（CR）、毒副作用和总生存（OS）、无事件生存（EFS）。比较分析不同危险因素分层亚组之间的治疗结果,观察规范化巩固、维持治疗及异基因造血干细胞移植（allo-HSCT）等因素对生存期的影响。结果：41例ALL患者无早期死亡,其中37例患者为CR,1疗程CR率为90.2%,随访至2015年3月17日,中位随访时间25（9-79）个月;1年OS率为75.3%,EFS率为58.3%。3年预期OS为48.6%,EFS率为37.5%。危险因素分析显示,初诊时白细胞计数≥30×10^9/L,LDH≥250 U/L,诱导治疗后微小残留病灶（M RD）水平〉10^-4是预后的不良因素。缓解后根据《2012年中国成人急性淋巴细胞白血病诊断与治疗专家共识》进行规范化巩固治疗或行异基因造血干细胞移植均能改善长期生存,3年OS分别为73.8%和61.5%、3年EFS分别为63.5%和65.7%。主要毒副作用是血液学毒性,诱导治疗中有97.6%（40/41）出现Ⅳ级血液学不良反应。结论：以VICP＋L-ASP/TKI为基础诱导化疗和缓解后根据《2012年中国成人急性淋巴细胞白血病诊断与治疗专家共识》进行规范化巩固治疗将有助提高疗效。对于初诊白细胞或LDH升高的高危患者,应积极实施造血干细胞移植,与此同时,规律监测MRD,根据MRD监测结果调整治疗方案,以改善成人ALL患者预后。

Objective：To evaluate the therapeutic efficacy of VICP ＋ L-ASP/TKI on adult patients with B-ALL and to explore the influence factors.Methods：Forty-one adult B-ALL patients treated with VICP ＋ L-ASP/TKI from August2008 to June 2014 were following-up.The complete remission（CR） rate,toxicity,overall survival（OS） and event free survival（EFS） after induction treatment were analyzed,the therapeutic outcome of patients between different risk stratification subgroups was compared,the influence of standardized consolidatory and maintaining treatment as well as allogeneic hematopoietic stem cell transplantation（allo-HSCT） on survival time was analyzed.Results：The early death not occurred in 41 patients with B-ALL including 37 cases with CR;the CR rate of 1 course treatment was 90.2%.The follow-up time lasted to March 17,2015,the median follow-up time was 25（9-79） months;the 1 year OS rate was75.3%,the EFS rate was 58.3%.Analysis of risk factors showed that the initial WBC count over 30×10^9/L,LDH over 250 U/L and minimal residual disease（MRD） over 10 after treatment were poor prognostic factors.After remission,the standardized consolidatory treatment or allo-HSCT according to the ＂2012 China adult ALL diagnosis and treatment expert consensus＂ could improve long-term survival,3 years OS rate was 73.8%and 61.5%respectively,3years EFS were 63.5%and 65.7%respectively.The main toxic and side effects were hematologic reactions,the hematologic adverse reaction of IV grade was observed in 97.6%（40/41） during induction treatment.Conclusion：Induction chemotherapy based on VICP ＋L-ASP/TKI and standardized consolidatory after remission according to the ＂2012 China adult acute lymphoblastic leukemia diagnosis and treatment expert consensus＂ can improve the therapeutic efficacy.The allo-HSCT should be actively performed for B-ALL paients with high risk（elevated initial WBC count and LDH level）;at some time,the regularly monitoring MRD and adjusting therapeutic protocol according to monitoring result can promote the prognosis of adult B-ALL patients.