86例成人Ph染色体阴性急性B淋巴细胞白血病自体造血干细胞移植疗效及微小残留病检测的临床意义

OBJECTIVE: To better understand predictive factors and role of autologous hematopoietic stem cell transplantation (auto-HSCT) in the post-remission therapy for adult Ph-negative B-cell acute lymphoblastic leukemia (B-ALL) patients. METHODS: Outcomes of 86 adult patients with B-ALL who received auto-HSCT in our center from January 1996 to February 2014 were retrospectively analyzed. RESULTS: Overall survival (OS) and disease free survival (DFS) at 5 years for the cohort were (63.8±5.6)% and (60.9±5.6)%, respectively. The cumulative non-relapse mortality (NRM) and relapse at 5 years were (4.70±0.05)% and (34.40±0.31)%. For DFS, age ≥35 years, high lactate dehydrogenase at diagnosis, high initial WBC count, blast cell proportion≥5% on 15th day of the first induction therapy, complete remession (CR)1 to HSCT interval >6 months and CD34(+) cells in graft≥3.8 × 10(6)/kg were the poor prognostic factors. CR1 to HSCT interval >6 months was the independently undesirable factors in COX regression model. For 34 patients who had results of minimal residual disease (MRD), positive pretransplantation MRD (MRD≥0.01%), positive post-induction MRD or MRD positive again during the chemotherapy indicated poor prognosis, and the last one was the independent adverse prognostic factor. CONCLUSION: Auto-HSCT combined with post-transplantation maintenance chemotherapy could be an optional approach for adult B-ALL patients. MRD plays a significant role in the treatment choice for adult Ph-negative B-ALL patients.