41例成人急性淋巴细胞白血病的预后分析  

Analysis of Survival and Prognostic Factors in 41 Cases of Adult Acute Lymphocytic Leukemia: A Retrospective Study

作　　者：胡炯[1] 沈志祥[1] 吴文[1] 李秀松[1] 孙慧平[1] 

机构地区：[1]上海第二医科大学附属瑞金医院血液科上海血液研究所,200025

出　　处：《上海第二医科大学学报》1999年第2期138-141,共4页Acta Universitatis Medicinalis Secondae Shanghai

摘　　要：目的为进一步探讨我国成人急性淋巴细胞白血病（ALL）患者的预后因素，分析了41例常规化疗成人ALL的疗效，并对其预后因素进行分析。方法分析我院在1993年6月至1997年10月收治VDP／VDLP方案化疗缓解的成人ALL病例41例，其中Ph染色体阳性3例，t（4；11）异位1例，复合染色体异位1例，正常染色体核型和无法评估者共7例。以VDP／VDLP和蒽环类＋Ara－C方案交替应用巩固。观察的截止期为1997年11月，进行生存分析及单因素预后分析（Kaplan－Meiyer、Gehan’swilcoxon检验、Log－rank检验）。结果41人成人ALL的疗效，24个月无病生存率（DFS）为4．6±4．7％。24个月总生存率（OS）为27．1±11．9％。与ALL预后相关因素为：初发时WBC＞＝20×109／L；诱导化疗后28d未缓解；中枢神经系统累及；ALL－L3型；ph＋，t（4；11）以及其他复杂染色体异常。结论常规化疗治疗成人ALL的长期疗较较差，尤其是有不良预后因素患者，需研究和采用针对性的强化治疗策略。Objective Adult acute lymphocytic leukemia (ALL) is a common disease which has a poor result compared with childhood ALL with conventional chemotherapy. we present here, the result of a retrospective analysis in 41 cases of adult ALL treated with conventional chemotherapy. Methods Forty -one de novo ALL patients were treated with standard VDP/VDLP chemotherapy and had complete remission (male 26 and female 15; age 18～55, median 32). There were three ph positive, one t(4;11) and one complex chromosomal abnormality in cytogenetic study. Univariate analysis was performed to identify the potential prognostic factors. Results The 24 - month disease-free survival (DFS) and overall - survival (OS) were estimated as 4.6i4.7 % and 27.h 11.9% respectively. Several important prognostic factors were identified: initial WBC≥20×109/L; no remission within 28days with induction treatment; CNS involvement; subtype of ALL - L3 and ph+, t(4:11) or other complex chromosomal abnormality. Conclusion The long-term result of adult ALL was disappointing with conventional chemotherapy, particularly for patients with negative prognostic factors. New strategy of more specific or intensified therapy should be studied.

关 键 词：白血病 生存 预后 ALL 

分 类 号：R733.710.7[医药卫生—肿瘤]