60岁以下成人Ph阴性急性淋巴细胞白血病患者自体造血干细胞移植疗效分析——单中心BDHALL2000/02方案临床研究结果

OBJECTIVE: To evaluate the results of autologous hematopoietic stem cell transplantation (auto-HSCT) in adults with Philadelphia chromosome-negative acute lymphoblastic leukemia (Ph(−)ALL). METHODS: From January 2000 to December 2007, the clinical data of auto-HSCT in adults Ph(−)ALL with complete remession (CR) 1 according to BDHALL2000/02 protocol were analyzed. RESULTS: A total of 56 patients were enrolled and the probabilities of standard risk, intermediated risk and high-risk group were 41.1%, 33.9%, and 25.0%, respectively. After a median follow-up of 75 months (range 7–177 months), the 5-year overall survival (OS), events free survival (EFS) and relapse free survival (RFS) were (51.8 ± 6.7)%, (51.8 ± 6.7)%, and (60.5 ± 6.9)%, respectively. And the 5-year accumulative relapse rate was (39.1±6.9)%. The 5-year OS of standard risk, intermediate risk, high-risk group were (60.9±10.2)%, (52.6±11.5)%, and (35.7±12.8)%, respectively. The 5-year RFS among three groups were (68.3±9.9)%, (62.5±12.1)%, and (44.9±14.1)%, respectively. The 5-year EFS among three groups were (60.9±10.2)%, (52.6±11.5)%, and (35.7±12.8)%, respectively. The 5-year accumulative relapse rate among three groups were (31.7±9.9)%, (37.5±12.1)%, and (55.1±14.1)%, respectively. There was no statistical significance of any survival rates between standard and intermediate risk groups, just as intermediate and high-risk groups. The OS and EFS in standard risk group were superior to those in high-risk group (P=0.040 and P=0.029, respectively), while there was no statistical significance of RFS and accumulative relapse rate between the two groups. The clinical factors listed below did not influenced the prognosis in the univariate analysis (P>0.05), including more than 5 weeks reaching to CR, WBC count at diagnosis, different immunophenotype (T or B cells), myeloid antigen expression, hyperdiploid chromosome karyotype, complex chromosome abnormality, conditioning regimen with or without TBI, duration between transplantation and diagnosis. CONCLUSION: Ph-ALL adults could achieve a satisfactory CR and better survial according to BDHALL2000/02 protocol followed by auto-HSCT, especially for the standard or intermediate risk group, and no-donors high-risk patients.