急性淋巴细胞白血病预后及其相关因素分析

急性淋巴细胞白血病预后及其相关因素分析1996-200553ALL64；181EFSOSEFSOSANC偏高者相对OS低。结论：急性淋巴细胞白【关键词】急性淋巴细胞白血病PrognosisandRelatedFactorsofLymphoblasticLeukemiaAbstractInordertoanalyzetheprognosisandrelatedfactorsoflymphoblasticleukemia(ALL),53diagnosedALLpatientswereenrolledinthisstudy.Thetherapeuticefficacyandprognosisof53casesofALLwereanalyzed,theremission,relapse,survivalwerestudied,andrelationbetweendifferentfactorsandprognosisofALLwereinvestigatedbycomparisonofcasesinsamestage.Theresultsshowedthatthecompleteremissionachievedin36outof53patients,totalremissionratewas%,thetotalrelapseratewas%,themediandurationwas6monthsafterremission.Medianoverallsurvival(OS)andmediamand1monthsafterremissionrespectively,OSandEFSrateof18monthwas%and%.ThepatientswithdifferentgenderhadsignificantlydifferentEFS.AgewasanindependentriskfactorofCRrate.WhitebloodcellcountandhemoglobinlevelofnewlydiagnosedpatientsweresignificantlycorrelatedwithOSandEFS.Absoluteneutrophilcount(ANC)attheendoftheinductionchemotherapywasanindependentrelatedfactorofOS,thehigherANC,theriskofdeath.Thepatientswithorwithoutchemotherapyrelatedinfectionhaddifferentrelapserate.ThepatientswithbleedingafterchemotherapyhadlowerOSwhencomparedwiththosewithoutbleeding.Serumglucoselevelwasasignificantnegativeprognosticfactor.Itisconcludedthatthereishigherrelapserate,poorprognosisadultALLincomparisonwithchildren.InordertodecreasetherelapserateandprolongtheEFS,individualtherapeuticalregimensandprophylaxisofcomplicatingdiseasesshouldbeappliedtoALLpatients.Keywordsacutelymphoblasticleukemia;prognosis;riskfactorsJExpHematol2007;15(5):1102-1106急性淋巴细胞白血病是一组异质性疾病，各♘型具有不同的生物学特征及预后特征。95左右成人患者可达到完全缓解(CR5(OS)分别为70%和35%［1。现对我19961220051253ALL深对该病的认识。材料和方法病例我院199612-200512ALL53292432(7-76)20岁患者104月。L115L224L3599B7T243135X，， ， ， ， ， ， ，， ， 。FAB354020%，22。化疗方案以长春新碱和强的松(VP)为基础，加柔红霉素、环磷酰胺(CTX)或左旋门冬酰胺酶为诱导方案，VDCP47例，VDLP4例，VDP2例，缓解后治疗用原方案、大剂量甲氨喋(MTX)、足叶乙甙和阿糖胞苷等强化治疗，继以 MTXCTX维持治疗，并给予预防性MTX鞘内注射复发后以原诱导方案或氨丫啶加阿糖胞苷再次诱导中枢神经系统复发予MTX鞘内注射。统计方法SPSS及CoxRegressiontχ2结果为%，总缓解率为%。3远期疗效6OS，1OS，18OS，2OS334无事件生存率6个月EFS1年EFS18EFS1个月。复发情况53例患者中复发20例，总复发率为%，其317615诱因。预后相关因素性别不同性别患者EFS1EFSOSsurvivalbetweendifferentgenders.30-20②21-5050检验，不同年龄组之间OS有显着性差异。EFSχ2缓解率的独立相关因素，年龄越大，相对缓解率则越低。血型按血型分为A、B、AB和O型4组，经 检验不同血型之间OSEFS均无显着性差异。检验对于OSEFS性差异，其与缓解率亦无相关性。疾病自身因素OSEFSFABL1、L2、L33OSEFS无相关。CoxRegressionOS和EFSWBCCoxRegressionHbWBCOSEFSOSEFSWBCHbRBCPlt起病时症状体征患者起病时出血、感染、OS、EFS、缓解率和复发率均无相关性。对于诱导化疗的反应诱导化疗后ANC经CoxRegressionANCOSRegressionOSANCANC的独立相关因素。诱导化疗中空腹血糖水平将53名患者按2mmol/Lmmol/L476OS1OSEFS着性差异。Figure3.Comparisonofoverallsurvivalbetweendifferentpatientswithdifferentserumglucoselevels.OSEFS着相关性，与缓解率和复发率亦无显着相关性。化疗相关并发症骨髓抑制期感染是化疗OSEFS1OSEFS1OSEFSOSEFSFigure4.Comparisonofoverallsurvivalbetweendifferentpatientswithandwithoutbleeding.医疗干预情况化学治疗经VDCP47VDLP42果显示接受不同化疗方案患者的各组相比OS、EFS和缓解率均无显着性差异。支持治疗患者化疗后粒细胞集落刺激因子、成分输血、隔离以及抗生素使用与否，OS、EFS讨论急性淋巴细胞白血病各♘型临床疗效差别ALLCR70%-80%，同儿童ALLALLCR70%-80ALLEFS30%-50%；若无条件进行造血干细胞移植，EFSALLCRALLOSEFS些持续缓解患者的失访及因经济原因部分患者放弃治疗有关。Shuster［4］POGSteinherzCCG否为ALLOS龄为CR612。目前对于划分儿ALL≥1≤919岁的青少年预后较差7。婴儿ALL患者之所以预后不佳，是因为大部分患者均存在MLLIrken等［8］1991-2000421814＜14146OSEFS14OSEFSALL359，年龄＜35岁为低风险因素，＞3560CRCR3OS10故作者认为对于这部分患者应使用更为安全有效的新药，一方面减轻化疗不良反应，另一方面降低耐药性［3。文献报道WBC＜30×109/L的 患者OS18%，其中年龄＜35405年OS为58当WBC≥200×109/L［1011WBCHbOSEFSWBCHbNg［12］研究结论相一致，这些结果提示年龄、WBCHb近年来，许多学者使用外周血原始淋巴细疗结束后MRD13Laughton［10通过对227例岁初治ALLANCMRDANC×109/L)5EFSANC×109/L)5EFSANCMRD5EFSANCMRDEFS疗后ANC故作者认为ANC1414ANCOSANCALL化疗多以长春新碱和强的松为基础，加用蒽环类和CTX或是 等药物。此类方案常见的并发症为抑制期感染出血和高血糖等。我们发现，化疗后感染与否为复率的独立相关因素，出现感染者复发率为%，无感染者复发率为%；而化疗后出血与否与OSEFSMRDALLOS。ALL的联合化疗方案中包括皮质激素，而高ALL治疗过程中并不少见。有研究提示，诱导化ALL发发并增加复发风险，可能是因为①增加化疗后的一项STI571酸的合成和白血病细胞的增殖，因此血糖水细胞的增殖。总之，急性淋巴细胞白血病的复发率高，出血，以减少复发，延长无病生存时间。【参考文献】1MortuzaFY,PapaioannouM,Moreiraetal.Minimalresidualdiseasetestsprovideanindependentpredictorofclinicaloutcomeinadultacutelymphoblasticleukemia.JClinOncol,2002;20:1094-11042LeClercJM,BillettAL,GelberRD,etal.Treatmentofchildhoodacutelymphoblasticleukemia:resultsof-2463LarsonRA.Acutelymphoblastic3LarsonRA.Acutelymphoblasticleukemia:olderpatientsandnewerdrugs.Hematology(AmSocHematolEducProgram),2005;131-1364ShusterJJ,WackerP,PullenJ,etal.Prognosticsignificanceofsexinlymphoblasticleukemia:aPediatricOncologyGroupStudy.JClinOncol,16:2854-28635SteinherzPG,GaynonPS,BrenemanJC,etal.Treatmentofpatientswithacutelymphoblasticleukemiawithbulkyphenotypeorotherpoorprognosticphenotypeorotherpoorprognosticfeatures:randomizedcontrolledtrialfromtheChildren‘sCancerGroup.Cancer,1998;82:600-6126GokbugetN,HoelzerD,ArnoldR,etTreatmentofadultALLaccordingtoprotocolsoftheGermanMulticenterStudyGroupforAdultALL(GMALL).HematolOncolClinNorthAm,2000;14:1307-13257FriedmannAM,WeinsteinHJ.Theroleofprognosticfeaturesinthetreatmentofchildhoodacutelymphoblasticleukemia.Oncologist,2000;5:321-3288IrkenG,OrenH,GulenH,etal.Treatmentoutcomeofadolescentswithacutelymphoblasticleukemia.AnnHematol,2002;81:641-6459CastagnolaC,LunghiM,CaberlonS,etacuteacutelymphoblasticleukaemiainadults:asinglecentreexperience.ActaHaematol,2005;113:234-24010LaughtonSJ,AshtonLJ,KwanE,etal.Earlyresponsestochemotheraphyofnormalandmalignanthematologicareprognosticinchildrenwithacutelymphoblasticleukemia.JClinOncol,2005;23:2264-2271CarlsenN,etal.OutcomeofchildrenCarlsenN,etal.Outcomeofchildrenintensiveregimenwithrestrictedcentralnervoussystemirradiation.PediatrBloodCancer,2004;42:8-2312NgSM,LinHP,AriffinWA,etal.Age,sex,haemoglobinlevel,andwhitecounta