44例青少年及年轻成人急性淋巴细胞白血病患者治疗的回顾性分析

Retrospective Analysis of the Impact of Treatment on Prognosis in 44 Adolescents and Young Adult Patients with Acute Lymphoblastic Leukemia

目的:分析在我院治疗的44例年龄介于15-39岁间的青少年和年轻成人(adolescents and young adults,AYA)急性淋巴细胞白血病(acute lymphoblastic leukemia,ALL)患者的临床特征及治疗方式对预后的影响。方法:回顾性分析1997年9月至2014年4月在我院治疗的44例AYA急性淋巴细胞白血病患者临床资料,观察治疗方案对总生存(overall survival,OS)和无事件生存(event free survival,EFS)的影响。结果:44例患者确诊时平均年龄23.7(15-37)岁,男女比例为2.38:1。1个疗程诱导化疗完全缓解(CR)率为88.6%,35名患者后续接受异基因造血干细胞移植(allo-HCT),6名患者接受维持化疗,3名患者接受自体造血干细胞移植(auto-HSCT)。全组患者预期3年OS及EFS分别为64.3%及61.7%,预期5年OS及EFS分别为55.4%及56.6%。接受allo-HSCT与非alloHSCT患者间的OS及EFS无统计学差异(P=0.308及P=0.291)。接受allo-HSCT患者中,治疗相关死亡率22.9%,标危与高危患者间OS及EFS无统计学差异(P=0.775及P=0.817)。标危AML患者中,接受allo-HSCT治疗的OS、EFS显著优于接受非allo-HSCT治疗者(P=0.0296及P=0.0359)。结论:allo-HSCT可能改善本组标危AYA急性淋巴细胞白血病患者的生存预后,但目前allo-HSCT在AYA急性淋巴细胞白血病中的治疗地位仍有争议,有待前瞻性随机临床研究进一步明确。

Objective:To study the clinical characteristics and the impact of treatment on prognosis in 44 adolescents and young adult(AYA) patients with acute lymphoblastic leukemia.Methods:Clinical data of 44 AYA ALL patients admitted in our hospital from September 1997 to April 2014 were analyzed retrospectively and the impact of treatment on overall survival(OS) and event free survival(EFS) were investigated.Results:The median age of the patients at diagnosis was 23.7(15- 37) years and the male/female was 2.38:1.Out of them 88.6%of patients achieved complete remission(CR) after 1 course of induction chemotherapy,35 patients received allogeneic hematopoietic stem cell transplantation(allo-HSCT) and 6 patients received chemotherapy,3 patients received autologous hematopoietic stem cell transplantation(auto-HSCT) as consolidation therapy in CR1.The expected 3-year OS and EFS rates of all the 44 patients were 64.3%and 61.7%respectively.The expected 5-year OS and EFS rates were 55.4%and 56.6%respectively.Allo-HSCT was not superior to chemotherapy and auto-HSCT in all the 44 patients(P = 0.308 for OS and P = 0.291 for EFS).In allo-HSCT group,the treatment related mortality was 22.9%,and the differences of OS and EFS in standard risk and poor risk AYA ALL patients were no significant(P = 0.775 for OS and P =0.817 for EFS).However,compared with chemotherapy and auto-HSCT,allo-HSCT could significantly improve the OS and EFS in standard risk AYA ALL(P =0.0296 for OS and P =0.0359 for EFS).Conclusion:Allo-HSCT as consolidation therapy may provide survival improvement for standard risk AYA ALL.However,further prospectively randomized clinical study is warranted to confirm whether allo-HSCT is an optimal treatment for AYA ALL,which is still controversial at present.