Ph染色体阳性急性淋巴细胞白血病的预后因素分析  

Prognostic significance of Ph-positive acute lymphoblastic leukemia

作　　者：周励[1] 胡炯[1] 陈娟[1] 杜圣红[1] 王爱华[1] 游建华[1] 吴文[1] 沈志祥[1] 李军民[1] 

机构地区：[1]上海交通大学医学院附属瑞金医院血液科,200025

出　　处：《中华血液学杂志》2014年第2期109-113,共5页Chinese Journal of Hematology

摘　　要：目的探讨Ph染色体阳性（Ph＋）和（或）BCR-ABL融合基因阳性急性淋巴细胞白血病（Ph＋ALL）的预后影响因素。方法回顾性分析72例Ph＋ALL患者资料。比较性别、年龄（以50岁为界）、诊断时高白细胞计数（〉30x109／L）、附加染色体异常、BCR．ABL转录本类型、伊马替尼治疗、异基因造血于细胞移植（allo．HSCT）和治疗1个疗程获得完全缓解（cR）等因素对患者疗效和生存的影响。采用COX回归模型进行多因素分析。结果72例Ph＋ALL患者均为B系表达，中位年龄40．5（13～68）岁，中位随访时间为11（0．2～96）个月。伊马替尼联合化疗组38例患者的总体CR率达97．4％，明显优于单纯化疗组（62．3％，P=0．019）。初诊时高白细胞计数和合并附加染色体异常对CR率无明显影响（P=0．392和P=-0．249）；伊马替尼联合化疗组患者的2年总生存（OS）率和无病生存（DFS）率分别为（28．9±7．4）％和（25．0：k7．4）％，明显优于单纯化疗组[（3．4~3．4）％和（3．4~3．4）％，P=-0．000]；allo．HSCT组患者4年OS率明显优于化疗组[（61．1m11．5）％对（5．6m3．1）％，P=0．000]；多因素分析显示伊马替尼治疗[RP=0．413（95％CIO．237～0．721），P=-0．002]、allo．HSCT[RR=0．175（95％CIO．075～0．389），P=0．000]和治疗1个疗程获得cR[RR=0．429（95％C10．245～0．750），P=0．003]是影响OS的独立预后因素。结论allo．HSCT是Ph＋ALL患者的最佳治疗选择；尽早使用伊马替尼能够使患者及早获得并维持CR，减少复发，为患者接受allo—HSCT提供更多的机会；对无条件进行移植的患者，伊马替尼联合化疗能改善预后。Objective To explore the prognostic significance of Ph-positive and/or BCR-ABL positive acute lymphoblastic leukemia （Ph＋ALL）. Methods A retrospective analysis of 72 patients with Ph ＋ ALL to probe prognostic factors including sex, age, high white cell counts at diagnosis, additional chromosome abnormality, BCR-ABL trsnscripts type, imatinib based therapy, allo-HSCT and complete remission （CR） after one-course induction on the outcomes of Ph＋ALL patients. Results Of 72 patients with median age 40.5 （13-68）years, 38 patients received imatinib plus chemotherapy. With median follow- up of 11 （0.2-96）months, total CR rate in patients receiving imatinib plus chemotherapy was higher than of patients receiving chemotherapy only（97.4% vs 62.3%, P=0.019）. High white blood counts at diagnosis or additional chromosome abnormality had no effects on CR rate. 2-year overall survival （OS） and disease free survival （DFS） in imatinib plus chemotherapy group were （28.94±7.4）% and（25±7.4）%, respectively, which were higher than those in chemotherapy group（P〈0.001 ）. OS rate in HSCT group was significantly higher than that in non-HSCT group [ （61.14±11.5）% vs （5.64±3.1）%, P〈0.001 ]. Multivariate prognostic analysis for OS showed that imatinib-based therapy [RR=0.413 （95% CI 0.237-0.721 ）, P=-0.002], allo- HSCT [RR=0.175（95% CI 0.075-0.389）, P=-0.000]and CR after one-course induction [RR=0.429（95% CI 0.245-0.750）, P=0.003] were of importance for survival. Conclusion allo-HSCT was an optimal choice for Ph＋ALL patients. Imatinib-based therapy could increase CR rate, maintain CR duration and decrease relapse, resulting in more chance of HSCT. Imatinib improved the outcomes of Ph＋ALL patients who werenot eligible for HSCT.

关 键 词：费城染色体 白血病 淋巴样 伊马替尼 造血干细胞移植 预后 

分 类 号：R733.71[医药卫生—肿瘤]