同济96方案序贯治疗Ph染色体阴性成人急性淋巴细胞白血病疗效分析

OBJECTIVE: To investigate the efficacy and side effects of the consecutive chemotherapeutic protocol, Tongji-96, for adult patients with Philadelphia chromosome negative acute lymphoblastic leukemia (Ph(−)aALL). METHODS: A retrospective analysis was conducted on 95 cases of Ph(−)aALL patients treated between January 2004 and December 2012 with Tongji-96 regimen in Tongji hospital, Shanghai. RESULTS: Among these 95 patients, the overall complete remission (CR) rate was 92.6%, 7-year overall survival (OS) and event-free survival (EFS) rates were (39.3±5.9)% and (31.5±5.3)%, respectively, with the median survival of 28 months. Based on multivariable COX proportional hazards regression model analysis, patients with the poor karyotype and failed to achieve CR after first course induction therapy had a higher risk of mortality compared to those who had good or normal cytogenetics and achieved CR after 1 course of induction treatment [the risk ratios (RR) were 3.380 (95% CI 1.530–7.463, P=0.003) and 3.005 (95% CI 1.522–5.933, P=0.002), respectively]. By means of Kaplan-Meier analysis and Log-rank test,patients aged less than 60 years and successively achieved CR after first induction therapy had more favorable 7-year OS and EFS rates. Patients with normal karyotype and hyperdiploidy had significantly higher 2-year OS and EFS rates compared with those with complex karyotype, t(4;11) translocation and other karyotypes. CONCLUSION: Age (60 years as the cut-off), treatment courses for achieving CR and cytogenetics were predictive factors for the prognosis of Ph(−)aALL from this retrospective study. As a comprehensive and sequential therapy protocol, Tongji-96 regimen was proved to obtain long-term survival, reduce risks for relapse and improve outcomes for part Ph(−)aALL patients.