中枢神经系统白血病临床特征、复发及预后因素分析  

Analysis of clinical features,factors associated with relapse and prognosis of patients with central nervous system leukemia

作　　者：李雪雪 许倩文 王兴兵[1,2] LI Xuexue;XU Qianwen;WANG Xingbing(Anhui Medical University Provincial Clinical College,Hefei,Anhui 230001,China;Department of Hematology,the First Affiliated Hospital of University of Science and Technology of China,Hefei,Anhui 230001,China)

机构地区：[1]安徽医科大学省立临床学院,安徽合肥230001 [2]中国科学技术大学附属第一医院血液科,安徽合肥230001

出　　处：《安徽医药》2025年第5期920-926,共7页Anhui Medical and Pharmaceutical Journal

摘　　要：目的探讨中枢神经系统白血病(CNSL)的临床特征、复发及预后因素。方法回顾性分析2015年6月至2022年12月中国科学技术大学附属第一医院收治的急性白血病合并CNSL病人临床资料,探究其临床特征、复发情况及预后相关因素。结果共纳入101例急性白血病合并CNSL病人,其中急性淋巴细胞白血病(ALL)病人73例(72.3%),急性髓系白血病(AML)病人28例(27.7%)。24(23.8%)例病人CNSL发生于初诊时,46例(59.7%)发生于骨髓缓解期,5例(6.5%)发生于骨髓未缓解期,26例(33.8%)发生于骨髓复发期。94例(96.9%)病人在接受CNSL相关治疗后达到中枢神经系统完全缓解(CR),38例(40.4%)病人在后续随访中出现2次或多次CNSL复发(其中ALL29例,AML9例)。鞘内注射(IT)化疗联合异基因造血干细胞移植(allo-HSCT)者的复发率低于未联合allo-HSCT者(19.0%比43.8%,P=0.039),且IT化疗联合allo-HSCT者中位无病生存期(DFS)(30±3.9)个月显著优于未联合allo-HSCT者(11.0±2.9)个月(P=0.015)。在初次诊断时,白细胞计数大于50×10^(9)/L亦是影响CNSL复发的高危因素(P=0.040)。对于ALL合并CNSL病人,初诊时高白细胞水平是病人DFS的危险因素(P=0.009)。101例病人的中位生存时间(mOS)为6.0(1.0,96.0)个月,联合allo-HSCT治疗者与单独化疗及放疗相比能获得更好的中位OS[(40.0±20.2)个月比(12.0±3.7)个月,P=0.041]。大于等于6次规范的IT化疗,亦可改善病人的中位OS[(30.0±8.7)个月比(7.0±2.6)个月,P=0.002]。针对ALL合并CNSL病人,联合HD-MTX化疗的病人相对于未联合HD-MTX者2年OS率更高[(64.9±11.7)%比(34.3±10.2)%,P=0.029]。结论对于急性白血病合并CNSL的病人,初诊时白细胞>50×10^(9)/L是影响其复发的高危因素。IT化疗基础上联合allo-HSCT能降低CNSL复发率、改善DFS及OS。大于等于6次规范的IT化疗,亦可改善病人的中位OS。对于ALL病人,初诊时白细胞增高是影响CNSL病人DFS的独立危险因素,选择HD-MTX方案化疗能�Objective To investigate the clinical features,factors associated with relapse and prognosis of patients with central nervous system leukemia(CNSL).Method We retrospectively analyzed the clinical data of acute leukemia patients with CNSL at the First Affiliated Hospital of University of Science and Technology of China from June 2015 to December 2022 to investigate the clinical features,factors related to relapse and prognosis.Results Data of 101 patients with CNSL were collected and analyzed,including 73(72.3%)cases of acute lymphoblastic leukemia(ALL)and 28(27.7%)cases of acute myeloid leukemia(AML).CNS involvement occurred in 24(23.8%)patients at the time of the initial leukemia diagnosis,in 46(59.7%)at the state of bone marrow remission,in five(6.5%)at bone marrow non-remission,and in 26(33.8%)at the state of relapse.Nighty-four(96.9%)patients achived CNS-CR after CNS-directed treatment,of whom 38(40.4%)had subsequent second or multiple CNS relapse(ALL,n=29;AML,n=9).The rate of CNS relapse in patients treated with intrathecal(IT)chemotherapy in combination with allogeneic hematopoietic stem cell transplantation(allo-HSCT)was lower than those without allo-HSCT(19.0%vs.43.8%,P=0.039),and the disease-free survival(DFS)of CNSL patients treated with IT chemotherapy combined with allo-HSCT(30.0±3.9)months was significantly superior than those without allo-HSCT(11.0±2.9)months(P=0.015).The leukocyte level greater than 50×10^(9)/L was also a high-risk factor for CNSL recrudesce.The high leukocyte level at initial diagnosis is a risk factor for DFS of the ALL patients with CNSL(P=0.009).The median overall survival(mOS)of the 101 patients was 6.0(1.0-96.0)months,chemotherapy or cranial radiation in combination with allo-HSCT resulted in better median OS compared with chemotherapy and cranial radiation alone[(40.0±20.2)months vs.(12.0±3.7)months,P=0.041].Patients with more than or equal to six cycles of standard IT chemotherapy showed longer median OS[(30.0±8.7)months vs.(7.0±2.6)months,P=0.002].The ALL patients w

关 键 词：急性白血病 中枢神经系统白血病 异基因造血干细胞移植 鞘内注射 影响因素 

分 类 号：R733.7[医药卫生—肿瘤]