摘要
目的:探讨成人费城染色体阳性急性淋巴细胞白血病(Philadelphia chromosome-positive acute lymphoblastic leukemia,Ph+ALL)患者化疗及酪氨酸激酶抑制剂(tyrosine kinase inhibitors,TKI)联合化疗作为首次诱导治疗的疗效及预后。方法:回顾性分析2012年1月至2023年10月就诊于宁夏医科大学总医院的60例成人Ph+ALL患者临床特点、生物学特征及完全缓解情况,分析其疗效及预后。结果:首次诱导治疗后达到完全缓解率(complete response,CR)的患者有43例,占71.67%(43/60),其中单纯化疗组7例,占41.18%(7/17),TKI+化疗组CR率为36例,占83.72%(36/43),且两组差异具有统计学意义(P=0.003)。单纯化疗组患者的2年总生存(overall survival,OS)率为28.2%,TKI联合化疗组患者的2年OS率为56%,差异具有统计学意义(P=0.041)。移植组与非移植组患者2年OS率76.9%vs. 51.9%,5年OS率56.1%vs. 19.4%,(P=0.003);2年无进展生存(progression-free survival,PFS)率38.5%vs. 12.1%(P=0.018),二者差异均具有统计学意义。单因素预后分析示,是否选择TKI、初次诱导治疗后是否获得CR和是否骨髓移植对OS预后差异均具有统计学意义(P<0.05);白细胞计数、是否选择TKI对患者无复发生存(relapse-free survival,RFS)率差异具有统计学意义(P<0.05)。Cox多因素预后分析示,诱导治疗后获得CR、后续接受造血干细胞移植为患者OS的独立预后因素。结论:Ph+ALL诱导治疗方案中,TKI+化疗诱导治疗方案能够实现早缓解,高缓解率,总生存期方面优于单纯化疗。缓解后进行骨髓造血干细胞移植治疗Ph+ALL预后良好。
Objective:To investigate the efficacy and prognosis of induction therapy combined with chemotherapy and tyrosine kinase inhib-itors(TKI)in adult Philadelphia chromosome–positive acute lymphoblastic leukemia(Ph+ALL).Methods:This study retrospectively analyzed the clinical features,biological characteristics,complete remission,curative effect,and prognosis of 60 adult patients with Ph+ALL treated in GeneraI Hospital of Ningxia Medical University from January 2012 to October 2023.Results:Among the patients,43(71.67%,43/60)achieved complete remission(CR)after the first induction therapy,including 7(41.18%,7/17)in the chemotherapy-alone group and 36(83.72%,36/43)in the TKI-plus-chemotherapy group(P=0.003).The 2-year overall survival(OS)rate of patients in the chemotherapy-alone group(28.2%)was significantly less than that of patients in the TKI-plus-chemotherapy group(56%,P=0.041).In the transplant and non-transplant groups,the 2-year and 5-year OS rates were 76.9%vs.51.9%,56.1%vs.19.4%,respectively(P=0.003).The 2-year progression-free survival(PFS)rate was better in the transplant group(38.5%)than in the non-transplant group(12.1%,P=0.018).Univariate prognostic analysis showed that whether TKI was selected,whether CR was obtained after the initial induction therapy,and whether bone marrow transplantation was performed,significantly affected OS prognosis(P<0.05).The white blood cell count and whether TKI was selected signi-ficantly affected the relapse-free survival(RFS)of patients(P<0.05).Cox multivariate prognostic analysis showed that CR,after induction therapy,and subsequent hematopoietic stem cell transplantation were independent prognostic factors for OS.Conclusions:In the Ph+ALL in-duction therapy regimens,TKI-plus-chemotherapy induction therapy can achieve early remission and a high remission rate,and the OS is better than chemotherapy alone.After CR,bone marrow hematopoietic stem cell transplantation for Ph+ALL had a good prognosis.
作者
马小楠
郑波
Xiaonan Ma;Bo Zheng(Department of Hematology,GeneraI Hospital of Ningxia Medical University,Yinchuan 750004,China;China Clinical Medicine School of Ningxia Medical University,Yinchuan 750004,China)
出处
《中国肿瘤临床》
CAS
CSCD
北大核心
2024年第6期287-292,共6页
Chinese Journal of Clinical Oncology
关键词
急性淋巴细胞白血病
费城染色体阳性
酪氨酸激酶抑制剂
化疗
acute lymphoblastic leukemia(ALL)
Philadelphia chromosome positive
tyrosine kinase inhibitors(TKI)
chemotherapy
