61例成人急性淋巴细胞白血病患者的临床特征和疗效分析  

Analysis of Clinical Characteristics and Therapeutic Efficacy in 61 Adult Patients with Acute Lymphoblastic Leukemia

作　　者：张孝平[1] 陈宝安[1] 葛峥[1] 刘苒[1] 马晓燕[1] 高冲[1] 

机构地区：[1]东南大学医学院附属中大医院血液科,江苏南京210009

出　　处：《中国实验血液学杂志》2017年第3期711-717,共7页Journal of Experimental Hematology

摘　　要：目的:探讨成人急性淋巴细胞白血病(acute lymphoblastic leukemia,ALL)患者的临床特征与疗效的关系。方法:回顾性分析2010年1月至2014年12月东南大学附属中大医院血液科连续收治的≥15岁的61例ALL患者临床资料。分析患者的临床和生物学特征与完全缓解率(CR)的关系。用COX回归进行与总生存时间(overall survival,OS)和无疾病生存时间(disease free survival,DFS)有关的危险因素的单因素和多因素分析。结果:61例患者经1个疗程诱导化疗后44例获得CR,总CR率72.13%。发病时年龄、初诊时外周血白细胞计数、初诊时有无CNS-L、髓系抗原表达、Ph染色体情况等均是影响诱导缓解率的重要因素(P<0.05)。61例患者2年OS率为28.13%,中位生存期为11个月(95%CI 9.58-12.42)。44例获得CR的患者中,2年OS率为39.57%,2年DFS率为34.29%。单因素分析显示,患者的发病年龄、初诊时WBC计数、诱导缓解是否达到CR、在CR后是否接受巩固治疗或异基因HSCT治疗,均为影响成人ALL的预后因素。多因素分析显示,发病时高龄(P=0.001)、诱导化疗未达到CR(P=0.018)及CR后未进行巩固治疗(P=0.027)是影响OS的独立危险因素;诱导化疗未达到CR(P=0.002)及CR后未进行巩固治疗(P=0.005)是影响DFS的独立危险因素。结论:成人ALL化疗的CR率高,但总OS率低,争取CR及在CR后继续巩固维持治疗可提高长期生存率。Objective： To investigate the clinical characteristics and curative effect in 61 adult patients with acute lymphoblastic leukemia （ALL）. Methods： The clinical data of 61 patients （ t〉 15 years old） with ALL enrolled from January 2010 to December 2014 were studied retrospectively. The relationship between clinical characteristics and curative effect was analyzed. The univariate and multivariate analyses related with the overall survival （OS） and disease free survival （ DFS ） were conducted by using the method of COX regression analysis. Results： Forty - four patients obtained complete remission （CR） in all 61 cases. The total CR rate was 72. 13%. Age of onset, WBC count at first visit, CNS involvement or not, status of myeloid antigen expression and Ph chromosome condition were the important factors affecting the CR rate （ P 〈 0.05 ）. The 2 years OS rate of all the 61 cases was 28. 13%, the median OS time was 11 months （95% CI9.58 - 12.42）. The 2 years OS rate and DFS rate of the 44 patients in CR were 39.57% and 34. 29% respectively. As showed by univariate analysis, the age of onset, WBC count at first visit, whether achieved CR or not after induction chemotherapy, and whether accepted consolidation therapy or allo-HSCT therapy after CR were factors affecting the prognosis of adult ALL patients. The result of multivariate analysis showed that the older age （P = 0. 001 ）, induction chemotherapy did not achieve CR （P = 0. 018） and patients did not received consolidation after CR （ P = 0. 005） , all these were independent risk factors for DFS. Conclusion： The CR rate after induction chemotherapy is high in adult ALL patients, but the OS rate is low. To achieve CR and to maintain consolidation treatment after CR mav be belnful to imrrove the lone-term survival.

关 键 词：成人急性淋巴细胞白血病 临床特征 疗效分析 

分 类 号：R733.71[医药卫生—肿瘤]