成人T细胞急性淋巴细胞白血病治疗及预后分析  

Treatment and Prognosis of Adult T Cell Acute Lymphoblastic Leukemia

作　　者：黄走方 王婷玉[1] 傅明伟[1] 刘薇[1] 郝牧[1] 邱录贵[1] 邹德慧[1] HUANG Zoufang;WANG Tingyu;FU Mingwei;LIU Wei;HAO Mu;QIU Lugui;ZOU Dehui(Department of Lymphoma Center,State Key Laboratory of Experimental Hematology,Institute of Hematology and Blood Diseases Hospital,CAMS and PUMC,Tianjin 300020,China)

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淋巴瘤中心实验血液学国家重点实验室

出　　处：《中国医学科学院学报》2019年第4期485-491,共7页Acta Academiae Medicinae Sinicae

基　　金：十二五国家科技支撑计划项目(2014BAI0912);国家自然科学基金(81630007);中国医学科学院医学与健康科技创新工程(CAMS-2017-I2M-1-005,CAMS-2016-I2M-3-013)~~

摘　　要：目的探讨成人T细胞急性淋巴细胞白血病的治疗与预后。方法回顾性研究2003年1月1日至2017年6月30日中国医学科学院血液病医院淋巴瘤中心收治的68例初治成人T细胞急性淋巴细胞白血病(T-ALL)患者,分析其疗效及预后。结果 68例成人T-ALL患者中位年龄23(14~60)岁,男性多见。第1疗程后完全缓解(CR)率73%,皮质T-ALL的CR率最高,其他T-ALL其次,早期前体T淋巴细胞白血病最低,分别为100%、73%、54%(χ^2=5.712,P=0.058);年龄>35岁病例组首疗程CR率低于≤35岁病例组(40%比79%,χ^2=6.364,P=0.012),性别、白细胞计数各组的首疗程CR率比较差异无统计学意义。第2疗程后总CR率93%。化疗、自体造血干细胞移植(auto-SCT)、异基因造血干细胞移植(allo-SCT)中位无进展生存时间分别为10个月、24个月、未达到(P=0.002)。5年总生存率为25%,化疗、auto-SCT、allo-SCT中位OS分别为24、34、30个月(P=0.007),5年总生存率分别为9%、33%、38%(P=0.037)。将性别、年龄、白细胞计数、达CR时间>4周、T亚型等因素进行多因素分析,结果显示白细胞计数≥100×10^9/L是影响无复发生存时间的危险因素(风险比2.540,95%CI=1.058~6.099,P=0.037)。结论成人T-ALL患者预后差,造血干细胞移植可能改善患者预后。Objective To analyze the treatment and prognosis of T cell acute lymphoblastic leukemia(T-ALL)in adults.Method The clinicobiogical and survival data of 68 adult patients with newly diagnosis T-ALL were retrospectively analzyed.Results The median age of these 68 patients was 23 years(14-60 years).T-ALL was more common in men(81%).After the first cycle of treatment,complete remission was achieved in 50 patients(73%).The highest complete remission(CR) rate was in patients with cortex T-ALL(100%),followed by other T-ALL(73%)and early T-cell precursor lymphoblastic leukemia(54%),(χ^2=5.712,P=0.058).The CR rate for adults aged >35 years was significantly lower than that of patients aged ≤ 35 years(40% vs. 79%,χ^2=6.364,P=0.012).The overall CR rate after the second treatment course was 93%.For patients treated with chemotherapy,autograft hematopoietic stem cell transplantation(auto-SCT),and allogeneic SCT,the median relapse free survival was 10 months,24 months,and not reached,respectively(P=0.002).The 5-year overall survival rate was 25% for all patients;for patients treated with chemotherapy,auto-SCT and allogeneic SCT,the median overall survival was 24 months,34 months,and 30 months,respectively(P=0.007),and the 5-year overall survival rate was 9%,33%,and 38%(P=0.037).Multivariate analysis showed leukocyte count ≥100×10^9/L was a risk factor for decreased relapse free survival(risk ratio 2.540,95%CI=1.058-6.099,P=0.037).Conclusion Adult T-ALL patients have poor prognosis,which may be improved by SCT.

关 键 词：白血病 淋巴样 治疗 预后 

分 类 号：R557.4[医药卫生—血液循环系统疾病]