152例成人急性淋巴细胞白血病患者的临床特点、治疗效果及预后分析

Analysis of clinical characteristics,therapeutic effect and prognosis of 152 adult patients with acute lymphoblastic leukemia

目的探讨成人急性淋巴细胞白血病(ALL)患者的临床特点、治疗效果及预后。方法回顾性分析152例初诊成人ALL患者的临床资料和免疫分型。根据免疫分型将T-ALL患者分为ETP-ALL和non-ETP-ALL两个亚组;根据融合基因及二代测序结果将B-ALL患者分为Ph^(+)ALL、Ph-like ALL、其他B-ALL三个亚组;分析不同亚组患者的临床特征。结果 152例ALL患者中,B-ALL 124例,T-ALL 28例。ETP-ALL组的WBC、LDH水平、首次诱导治疗CR率低于non-ETP-ALL组,血小板计数高于non-ETP-ALL组,差异具有统计学意义(P<0.05)。Ph^(+)ALL组、Ph-like ALL组及其他B-ALL组的年龄、WBC、LDH水平比较,差异具有统计学意义(P<0.05)。ETP-ALL组与non-ETP-ALL组的15个月OS率无显著差异,Ph^(+)ALL组和Ph-like ALL组及其他B-ALL组的1年OS率无显著差异(P>0.05)。结论ETP-ALL患者具有低WBC、低LDH水平、高血小板计数等临床特点,且诱导治疗效果不佳;Ph^(+)ALL患者具有高龄、高WBC、高LDH水平等临床特点。积极接受异基因造血干细胞移植可以显著改善成人ALL的预后。

Objective To investigate the clinical characteristics,therapeutic effect and prognosis of 152 adult patients with acute lymphoblastic leukemia(ALL).Methods The clinical data and immunotypes of 152 newly diagnosed adult ALL patients were retrospectively analyzed.According to the immunotypes,T-ALL patients were divided into two subgroups:ETP-ALL and non-ETP-ALL;according to the results of fusion genes and next-generation sequencing,B-ALL patients were divided into three subgroups:Ph^(+)ALL,Ph-like ALL and other B-ALL.The clinical characteristics of patients in different subgroups were analyzed.Results Among 152 ALL patients,124 cases were B-ALL and 28 cases were T-ALL.The WBC,LDH level and CR rate of the first induction therapy in the ETP-ALL group were lower than those in the non-ETP-ALL group,the platelet count was higher than that in the non-ETP-ALL group,and the differences were statistically significant(P<0.05).There were significant differences in age,WBC and LDH level among the Ph^(+)ALL group,Ph-like ALL group and other B-ALL groups(P<0.05).There was no significant difference in the 15-month OS rate between the ETP-ALL group and non-ETP-ALL group,and there was no significant difference in the 1-year OS rate between Ph^(+)ALL group and Ph-like ALL group and other B-ALL groups(P>0.05).Conclusion ETP-ALL patients have clinical features such as low WBC,low LDH level and high platelet count,and not good effect of induction therapy;Ph^(+)ALL patients have clinical features such as advanced age,high WBC,and high LDH level.Actively accepting allogeneic hematopoietic stem cell transplantation can significantly improve the prognosis of adult ALL.