成人急性淋巴细胞白血病缓解后治疗开始时间对预后影响研究  

Time to post-remission therapy is an independent prognostic factor in adults with acute lymphoblastic leukemia

作　　者：孙秀娟[1] 秘营昌[1] 傅明伟[1] 王迎[1] 刘凯奇[1] 林冬[1] 卞寿庚[1] 王建祥[1] 

机构地区：[1]中国医学科学院北京协和医学院血液病研究所血液病医院,天津300020

出　　处：《中国实用内科杂志》2009年第10期920-923,共4页Chinese Journal of Practical Internal Medicine

基　　金：国家科技支撑计划课题(2008BAI61B01)

摘　　要：目的分析影响成人急性淋巴细胞白血病(ALL)的预后因素及缓解后治疗(PRT)开始时间(PRTT)对预后的影响。方法回顾性分析中国医科科学院血液病医院1998年6月至2007年12月新诊断并完成1个疗程诱导治疗的ALL患者153例。用COX回归进行危险因素分析,确定与完全缓解(CR)率、总存活(OS)率、无进展存活(DFS)率有关的单变量和多变量。结果(1)单变量分析预后相关因素包括:诊断时的年龄(按10年增加)>20岁、白细胞≥50×109/L、高危细胞遗传学、28d是否达CR和PRTT。多因素分析证明,PRTT≥7.1周是显著的预后不良因素,与DFS[HR1.74,95%CI(1.10～2.76),P=0.018]及OS[HR1.64,95%CI(1.02～2.62),P=0.005]的降低显著相关。(2)细胞遗传学为标危组的患者,多因素分析显示,就诊时年龄>20岁、白细胞≥50×109/L、PRTT是显著预后因素,PRTT≥7.1周预后包括DFS[(HR2.32,95%CI(1.30～4.13),P=0.004]和OS[HR2.64,95%CI(1.47～4.73),P=0.001]较差。高危组患者,PRTT与预后(DFS和OS)无关。结论诱导治疗至PRT开始的时间是影响成人ALL的独立预后因素,成人ALL的缓解后治疗应及时进行。Objective To analyze the prognostic factors of adults with acute lymphoblastie leukemia and evaluate the impact of time from induction chemotherapy to post-remission therapy on prognosis. Methods We retrospectively evaluated 153 patients with newly diagnosed ALL treated at Institute of Hematology ＆ Blood Diseases Hospital, Chinese Academy of Medical Science ＆ Peking Union Medical College from August 1998 to December 2007. Cox regression analysis was used to identify univariate and multivariate correlates of CR, overall survival, and progression-free survival. Results （ 1 ） On univariate analysis ,significant prognostic factors included： age （ 〉 20 years old ） at diagnosis （per lO-year increase ）, white blood cell count （ ≥50 × 10^9/L） , not achieving complete remission on Day 28, poor risk cytogeneticsand time to post-remission therapy. Time from induction chemotherapy to post-remission（ ≥7.1 weeks） was confirmed to be a significant prognostic factors, which was associated with a significantly decreased Disease-Free Survival （DFS） [ HR 1.74,95% CI （ 1.10 - 2. 76）, P = 0. 018 ] and Overall Survival （OS） [ HR 1.64,95 % CI （ 1.02 - 2.62 ）, P = 0. 005 ]. （ 2 ） In stardard risk group, age at diagnosis （ 〉 20 years old）, white blood cell count （ ≥50×10^9/L） ,time to post-remission therapy were significant prognostic factors by mtdtivariate analysis. Delayed time from induction chemotherapy to post-remission （ ≥7. 1 weeks） was demonstrated to be a prognostic factor,which was associated with decreased DFS[ HR 2. 32,95% CI （ 1.30 - 4. 13 ）, P = 0. 004 ] and OS [ HR 2. 64,95 % CI （ 1.47 - 4.73 ）, P = 0. 001 ] poor risk cytogenetiesand, time to postremission therapy were no significant prognostic factors by multivariate analysis. Conclusion Time to post-remission therapy is an independent prognostic factor in adults with acute lymphoblastie leukemia.

关 键 词：急性淋巴细胞白血病 缓解后治疗时间 

分 类 号：R5[医药卫生—内科学]