2000–2013年成人急性淋巴细胞白血病患者疗效单中心分析

OBJECTIVE: To compare the outcomes of patients with adult acute lymphoblastic leukemia (ALL) over the last 14 years by taking 2006 as the demarcation point. METHODS: From January 2000 to December 2013, 477 consecutive hospitalized patients with adult ALL were retrospectively analyzed, including 276 (57.9%) with Ph negative B-ALL (Ph(−)-B-ALL) B-ALL, 69 (14.5%) with T-ALL and 132 (27.7%) with Ph positive ALL (Ph(+)-ALL); 111 (23.3%) before 2006 and 366 (76.7%) after 2006. Among 435 patients who achieved complete remission (CR), 248 (57.0%) received allogeneic hematopoietic stem cell transplantation (allo-HSCT), and 187 remained on chemotherapy. RESULTS: With a median follow-up period of 19 months in all patients and 35 months in living patients, overall CR rate was 92.0%. Of 435 CR patients, the cumulative incidences of 5-year relapse, disease-free survival (DFS) and overall survival (OS) rates were 42.5%, 46.2% and 47.6%, respectively. Compared with the patients hospitalized before 2006: ①the Ph(+)-ALL patients hospitalized after 2006 achieved a higher overall CR rate (P=0.036). There was no difference for CR rates of Ph(−)-B-ALL and T-ALL patients between before and after 2006. ②The CR patients hospitalized after 2006 had higher 5-year DFS and OS rates (P=0.001; P<0.001), including higher 5-year OS rate in Ph(−)-B-ALL patients (P=0.046), and higher 5-year DFS and OS rates in both T-ALL (P=0.013; P=0.036) and Ph(+)-ALL patients (P=0.003; P<0.001), especially in those Ph(+)-ALL patients who received imatinib from the beginning of the induction chemotherapy (P<0.001; P<0.001). ③The patients who received allo-HSCT after 2006 had higher 5-year DFS and OS rates (P=0.001; P<0.001), but there was no difference for the outcomes in those who remained on chemotherapy before and after 2006. After 2006, Ph (+)-ALL patients who received imatinib from the beginning of the induction chemotherapy had the highest 5-year DFS and OS rates compared with Ph(−)-B-ALL and T-ALL patients (P=0.009; P=0.001). Multivariate analysis showed that allo-HSCT and imatinib were two important factors affecting the outcomes of ALL patients. CONCLUSION: The outcomes of ALL patients improved significantly over the last 14 years, especially in Ph (+)-ALL ones.