不同诱导化疗方案对成人急性淋巴细胞白血病疗效的影响  

Influence of different induction chemotherapy regimens on efficacy of adult 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：《临床血液学杂志（输血与检验）》2010年第3期350-353,共4页Journal of Clinical Hematology(Blood Transfusion & Laboratory Medicine)

基　　金：国家科技支撑计划课题(No:2008BAI61B01);重大新药创制(No:l2008ZXO9312-026)

摘　　要：目的:比较成人急性淋巴细胞白血病(ALL)患者不同诱导化疗方案治疗的疗效。方法:回顾性分析医科院血液病医院从1998年6月—2008年1月新诊断、治疗的ALL患者124例。采用SPSS13.0统计学软件分析有关数据。结果:①根据诱导治疗方案分为VDCLP、VDCP2组,2组的1疗程CR率为87.9%和84.5%,总CR为93.9%和89.7%。VDCLP组中位无病生存(DFS)21(0～116)个月,中位总生存(OS)23(2～117)个月;VDCP组中位DFS10(0～109)个月,中位OS14(1～110)个月。2组的3年DFS分别为55.2%和19.2%。2组的3年OS率56.2%和21.1%,(P<0.05)。②≤30岁的青少年和年轻成人ALL采用VDCLP和VDCP方案1疗程CR率分别为92.7%和86.8%,总CR率分别为97.6%和94.7%。VDCLP组中位DFS23(0～116)个月,中位OS24(2～117)个月;VDCP组中位DFS10(0～109)个月、中位OS14(1～110)个月。2组的3年DFS分别为60.4%和18.2%。2组的3年OS率62.9%和20.9%。③采用VDCLP方案诱导治疗的染色体核型标危组成人ALL,VDCLP组中位DFS22(0～116)个月、中位OS24(3～117)个月;VDCP方案诱导治疗中位DFS13(0～109)个月、中位OS19(1～110)个月。2组的3年DFS分别为59.0%和DFS23.3%。2组的3年OS率60.7%和29.8%。而染色体核型高危成人ALL,VDCLP组中位DFS6(0～32)个月,中位OS17(2～38)个月;VDCP组中位DFS8(0～20)个月,中位OS10(5～23)个月。2组的3年DFS分别为0.0%和DFS0.0%。2组的3年OS率0.0%和0.0%。结论:诱导治疗中加L-Asp对CR率无明显影响,但诱导治疗采用VDCLP较VDCP可以提高成人ALL的DFS和OS。Objective：To compare responses in the patients with adult acute lymphoblastic leukemia （ALL） to different induction chemotherapy regimens. Method： 124 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 January 2008 were retrospectively evaluated and data was analyzed with the statistical software of SPSS13. 0. Result： （1）The patients were divided into two groups, named VDCLP and VDCP, based on the regimens they underwent. Complete remission （CR） rates for the two groups after one cycle of chemotherapy were 87. 9 % and 84. 5 %, and the total CR for the two groups were 93. 9% and 89. 7%, respectively. In VDCLP group, median disease free survival （DFS） was 21 （0-116） months and median overall survival （OS） was 23 （2-117） months. Median DFS and OS of VDCP group were 10（0-109） months and 14（1-110） months respectively. Three years DFS was 55. 2% and 19. 2% for the two groups respectively, and three years OS for them were 56. 2% and 21. 1% respectively. （2）For adolescents and young adults （430 years）, CR rates were 92. 7% and 86. 8% respectively in VDCLP group and VDCP group after 1 cycle, the total CR rates were 97. 6% and 94. 6% respectively. Median DFS was 23 （0-116） months and 10 （0-109） months, median OS 24 （2-117） months and 14（1-110）. months for the two groups respectively. Three-year DFS were 60. 4% and 18. 2% ,OS were 62. 9% and 20. 9% respectively for VDCLP and VDCP groups. （3）According to karyotype analysis, for patients with the standard-risk karyotypes, three-year DFS were 59. 9 % and 23. 3% for VDCLP and VDCP groups, three-year OS were 60. 7% 和 29. 8%; for patients with high-risk karyotypes, three-year DFS and OS for the two groups were all 0 %. Conclusion.. Addition of L-Asp to the induction chemotherapy did not affect CR rate, but could improve the survival.

关 键 词：ALL 诱导治疗 VDCLP VDCP 

分 类 号：R733.71[医药卫生—肿瘤]