55岁以上中老年急性淋巴细胞白血病患者的临床特征与疗效分析  

Clinical characteristics and efficacy analysis for patients over 55 years of age with acute lymphoblastic leukemia

作　　者：王婧[1] 黄晓军[1] 江滨[1] 江倩[1] 卢锡京[1] 许兰平[1] 刘代红[1] 陈欢[1] 鲍立[1] 路瑾[1] 主鸿鹄[1] 江浩[1] 

机构地区：[1]北京大学人民医院血液病研究所,北京100044

出　　处：《北京大学学报（医学版）》2013年第6期938-944,共7页Journal of Peking University:Health Sciences

基　　金：国家自然科学基金(81230013);首都卫生发展科研专项基金(2011-4022-08)资助~~

摘　　要：目的：分析中老年急性淋巴细胞白血病（acute lymphoblastic leukemia, ALL）患者的临床特征与疗效。方法：回顾性分析2000年1月至2012年7月北京大学人民医院血液病研究所连续收治的≥55岁ALL患者45例。根据患者脏器功能，分别接受CVDP/VDP/VP诱导化疗，达到完全缓解（complete remission, CR）的患者接受巩固化疗和维持化疗或随诊观察，有合适供者行异基因造血干细胞移植（allogeneic hematopoietic stem cell transplantation, allo-HSCT）。评估患者CR率，分析患者总生存时间（overall survival, OS）、无疾病生存时间（disease free survival, DFS）及累计复发率。结果：45例≥55岁ALL患者占同期470例ALL患者的9.6%，其中B-ALL占88.9%。第1次诱导化疗后27例获得CR，总CR 33例。与55~60岁患者相比，大于60岁患者总CR减低（86.2% vs. 50%；P=0.009）。45例患者2年OS 率为33.7%，中位OS为 12个月（95% CI 6.68~17.32）。55~60岁（P=0.014）、进行巩固治疗（P=0.001）及CR（P=0.002）是独立影响OS的有利因素。33例获得CR的患者中，2年DFS率为39.7%。CVDP诱导化疗方案（P=0.013）及进行巩固治疗（P=0.049）是独立影响DFS的有利因素。结论：中老年ALL患者预后较差，55~60岁、CR、CVDP诱导化疗方案及进行巩固治疗是独立的改善预后因素。We investigated the clinical characteristics and therapeutic of elderly patients （≥55） with acute lymphoblastic leukemia （ALL）. Methods： From Jenuary 2000 to July 2012, 45 elderly patients （≥55） were enrolled in the study. Patients assighed into CVDP VDP/VP induction chemotherapy based on organ function. Patients in complete remission （CR） undertake consolidation therapy, maintenance therapy or follow up. The patient who had appropriate donor received allogeneic hematopoietic stem cell transplantation （allo-HSCT）. CR, Overall survival （OS）, disease free survival （DFS）, relapse rate and prognosis factors were analyzed. Results： 45 elderly patients （≥55） about 9.6% in all 470 cases ALL simultaneity, and B-ALL about 88.9%. 27 patients （60%） obtained CR after 1 cycle of induction chemotherapy. 33 patients （73.3%） obtained overall CR. The CR rate significantly decreased in the elderly patients more than 60 years old vs. 55-60 years old patients （86.2% vs. 50%;P=0.009）. All 45 patients 2 years OS rate was 33.7%, The median OS was 12 months （95%CI,6.68-17.32）. 55-60 years （P=0.014）, CR （P=0.002） and consolidation therapy （P=0.001） were independent favorite prognostic factors for OS. CVDP induction chemotherapy （P=0.013） and consolidation （P=0.049） were independent favorite prognostic factors for DFS. Conclusion： The outcomes of elderly patients with ALL were poor, 55-60 years, CVDP induction chemotherapy, CR and consolidation therapy were independent favorite prognostic factors.

关 键 词：白血病 淋巴细胞 急性 老年人 预后 

分 类 号：R733.711[医药卫生—肿瘤]