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目的评价按照中国成人急性淋巴细胞白血病(ALL)协作组制定的成人ALL序贯化疗整体方案(CALLG2008)治疗60岁以下初发成人B细胞ALL(B-ALL)的疗效,并比较分析不同危险因素分层亚组之间的治疗结果,观察异基因造血干细胞移植(Allo-SCT)对患者生存期的影响。方法对2009年3月至2014年8月接受CALLG2008方案治疗的60岁以下初发成人B-ALL患者39例进行随访,分析接受该方案诱导治疗后患者的完全缓解(CR)率、毒性反应和总生存(OS)、无事件生存(EFS)情况。结果39例患者中3例早期死亡,其余36例中33例获CR,1个疗程CR率为91.7%。随访至2014年8月1日,中位随访时间25个月;预计3年OS率为53.7%,EFS率为45.6%。预后因素分析提示,患者年龄>35岁以及初诊时白细胞计数>30×109/L是预后的不良因素。Allo-SCT能显著延长患者尤其是高危组患者的OS期及EFS期。主要不良反应为血液学毒性反应,诱导治疗中有88.9%(32/36)出现Ⅳ级血液学毒性反应。结论 CALLG2008方案治疗60岁以下成人B-ALL有较高CR率及长期生存。患者年龄和初诊时白细胞计数是影响预后的重要因素。Allo-SCT可明显延长OS期。
Objective To evaluate the efficacy of CALLG2008 in the treatment of ALL B-ALL patients under the age of 60 years according to the Chinese ALL program and the comparison of different risk factors The results of the treatment between stratified subgroups and the effects of allogeneic hematopoietic stem cell transplantation (Allo-SCT) on the survival of patients were observed. Methods 39 cases of B-ALL patients younger than 60 years of age who underwent CALLG2008 from March 2009 to August 2014 were followed up. The rates of complete remission (CR), toxicity and Total Survival (OS), Event-Free Survival (EFS). Results Three of the 39 patients died early and 33 of the remaining 36 patients received CR. The response rate of one course of treatment was 91.7%. Followed up to August 1, 2014, the median follow-up time was 25 months. The 3-year OS was estimated at 53.7% and the EFS rate was 45.6%. Prognostic factors suggest that patients aged> 35 years and newly diagnosed white blood cell count> 30 × 109 / L is an adverse prognostic factor. Allo-SCT significantly prolonged OS and EFS in patients, especially in high-risk patients. The main adverse reactions were hematological toxicities. Grade IV hematologic toxicities occurred in 88.9% (32/36) of the induction therapies. Conclusion CALLG2008 treatment of adults under the age of 60 B-ALL have a higher CR rate and long-term survival. Patients age and initial diagnosis of white blood cell count is an important factor affecting the prognosis. Allo-SCT can significantly extend the OS period.