论文部分内容阅读
目的:分析诱导缓解后不同巩固治疗方案对青少年与年轻成人Ph-急性B淋巴细胞白血病(Ph-B-ALL)的治疗效果及不同危险因素对预后的影响。方法:回顾性分析解放军总医院血液科(65例)与解放军第三〇九医院血液科(15例)1999-2016年收治的16-39岁Ph-B-ALL患者的治疗及疗效数据。对患者以4药或者5药行联合诱导化疗(VDCLP/VDLP/DOLP/IOLP),获得缓解后行序贯儿童方案化疗,巩固化疗3到5疗程后行全相合异基因造血干细胞移植(allo-HSCT)和巩固化疗3到5疗程后行单倍体相合造血干细胞移植(haploidenticalHSCT)。患者中位随访时间29(6-153)个月。结果:在完全缓解CR1后行allo-HSCT,全相合HSCT组(n=29)5年OS为(73±16)%,EFS为(67±17)%;单倍体相合HSCT组(n=20)5年OS为(53±22)%,EFS为(53±22)%;在CR1行儿童方案化疗组(n=31)5年OS为(63±17)%,EFS为(50±18)%。3组之间OS与EFS均无显著的统计学差异(P>0.05)。儿童方案累积治疗相关死亡率低于allo-HSCT(P<0.05),疾病累积复发率具有高于allo-HSCT的趋势,但无统计学差异(P>0.05)。复发患者的再缓解率为(50±23)%,CR2患者持续缓解中位时间为14(2-36)个月。对解放军总医院65例患者进行了单因素与多因素分析显示,CD13~+或CD33~+,CD22~-提示预后较差(P<0.05)。结论:对于青少年与年轻成人Ph~- B-ALL患者,儿童方案化疗可使患者获得与allo-HSCT相近的生存时间,但需要扩大病例数并进行随机对照的前瞻性临床研究加以证实。
OBJECTIVE: To analyze the effect of different consolidation treatment regimens on the prognosis of adolescent and young adult patients with Ph-B-ALL and the different risk factors after induction remission. Methods: The data of treatment and efficacy of Ph-B-ALL patients aged 16-39 years admitted in Department of Hematology, PLA General Hospital (65 cases) and Department of Hematology, 309th People’s Liberation Army (15 cases) from 1999 to 2016 were retrospectively analyzed. The patients were treated with 4 or 5 drug combination chemotherapy (VDCLP / VDLP / DOLP / IOLP), and received sequential chemotherapy regimen of children. After 3 to 5 cycles of chemotherapy, allogeneic allogeneic hematopoietic stem cell transplantation (allo- HSCT) and consolidation chemotherapy 3 to 5 courses of haploidentical hematopoietic stem cell transplantation (haploidenticalHSCT). The median follow-up time was 29 (6-153) months. Results: The 5-year OS was (73 ± 16)% and EFS was (67 ± 17)% in all-HSCT group (n = 29) The 5-year OS was 53 ± 22% and the EFS was 53 ± 22%. The 5-year OS was (63 ± 17)% and the EFS was (50 ± 18)%. OS and EFS between the three groups showed no significant statistical difference (P> 0.05). Cumulative treatment-related mortality in children was lower than in allo-HSCT (P <0.05), and the cumulative recurrence rate was higher in all children than in allo-HSCT (P> 0.05). The remission rate was (50 ± 23)% in relapsed patients and 14 (2-36) months in CR2 patients. Univariate and multivariate analysis of 65 PLA patients showed that CD13 ~ + or CD33 ~ +, CD22 ~ - showed a poor prognosis (P <0.05). CONCLUSIONS: Child-centered chemotherapy in children and young adult patients with Ph-B-ALL can result in similar survival time to allo-HSCT but need to be expanded and prospective randomized controlled trials confirm this.