101例成人急性淋巴细胞白血病常用临床指标与预后的关系

Relationship between prognosis and commonly used clinical indicators in 101 adult patients with acute lymphoblastic leukemia

目的探讨常用临床指标在急性淋巴细胞白血病(ALL)预后中的意义。方法收集101例成人急性淋巴细胞白血病资料,按照MRC UKALL XII/ECOG2993研究标准的危险度分级将其分为标危组(n=34)和高危组(n=67),分析其免疫表型、造血干细胞移植及细胞遗传学特征,比较不同危险度分级、免疫表型、造血干细胞移植以及细胞遗传学对预后的影响。结果标危组总生存率(OS)优于高危组,但差异无统计学意义(P>0.05),无病生存率(DFS)优于高危组且差异有统计学意义(P<0.05)。CD10阳性ALL的OS及DFS较阴性者好,不伴髓系抗原表达ALL的OS及DFS较伴髓系抗原表达的好,但差异均无统计学意义(P>0.05)。造血干细胞移植能够明显改善ALL患者OS及DFS(P<0.05),其中对标危组预后差异无统计学意义(P>0.05),对高危组预后差异有统计学意义(P<0.05)。结论目前常用的临床指标对于ALL的预后判断有重要价值,但尚存在一定局限性,ALL的预后指标需要进一步探索和完善。

Objective To investigate the prognostic value of the commonly used clinical indicators for adult acute lymphoblastic leukemia （ALL）. Methods Immune phenotype, cytogenetic characteristics and transplantation of 101 patients with adult acute lymphoblastic leukemia, who admitted to the hospital during the period from 2010 to 2014, were collected according to the current prognosis standard, and the prognosis impact was analyzed. Results The survival rate （OS） of the standard risk was higher than that of the high risk group, but was not significant （P〉0.05） ; the disease free survival rate （DFS） of the standard risk group was significantly higher than that of the high risk group （P〈0.05）. A better prognosis trend exists in CD10 positive ALL than CD10 negative ALL （P〉0.05）. Expression of myeloid antigen showed disadvantage in both OS and DFS （P〉0.05）. Hematopoietic stem cell transplant showed significant difference in high-risk patients both in OS and DFS （P〈0.05） , but not in standard-risk （P〉0.05）. Conclusion The current common clinical indicators have limited value on prognosis of acute lymphoblastic leukemia, and better indicators need to be investigated.