应用儿童方案治疗成人急性淋巴细胞白血病的疗效及预后分析

发布时间：2018-03-12 13:01

  本文选题：急性淋巴细胞　切入点：白血病　出处：《大连医科大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的:回顾性分析大连医科大学附属第二医院血液科成人急性淋巴细胞白血病(acute lymphoblastic leukemia,ALL)应用儿童方案及成人方案的病例的临床资料和治疗疗效,比较并分析两者的预后。方法:收集2011年1月18日-2014年1月18日大连医科大学附属第二医院血液科35例应用儿童方案及20例应用成人方案的初发成人ALL,统计患者的临床信息,包括年龄、性别、确诊日期、疾病诊断、发病情况,记录初诊时血常规、骨髓原始细胞比例、染色体分析、免疫学分型及融合基因等实验室检查结果,明确每个病人的危险度分层、ECOG评分、治疗方案、第一次诱导缓解达CR(complete remission)时间,观察化疗药物副反应、感染情况、生存期、无病生存期、死亡原因等。采用SPSS16.0统计学软件分析结果。P0.05具有统计学意义。结果:1.一般特征:儿童方案组:入组35例患者,男:女=1:1.2,中位年龄33(16-56)岁。其中标危组18例(51%),高危组17例(49%)。B-ALL 32例(91%),T-ALL 3例(9%)。成人方案组:入组20例患者,男:女1:1.2,中位年龄33.5(15-57)岁。其中标危组15例(75%),高危组5例(25%)。B-ALL 16例(80%),T-ALL 4例(20%),2.疗效:儿童方案组:35例成人ALL采用儿童方案首次诱导化疗CR率91%,NR(non-remission)率9%,达CR1所用时间4周患者占71%,≥4周占29%。除外3例采用异基因造血干细胞移植(Allo-HSCT)外,其他32例中有14例(44%)出现复发。成人方案组:20例成人ALL采用成人方案首次诱导化疗CR率(70%),NR率30%,其中达CR1所用时间4周的患者占71%,≥4周占29%,13例(65%)出现复发。儿童方案组与成人方案组首次诱导化疗后达CR率分别为91%和70%,两组间对比有统计学差异(P=0.039)。儿童方案组年龄≥35岁的16例患者首次诱导CR率为94%,成人方案组≥35岁的7例患者首次诱导CR率为29%,两者差异(P=0.001)有统计学意义。儿童方案组白细胞(white blood cell,WBC)≥30×109/L(B-ALL)的10例患者首次诱导CR率为90%,成人方案组WBC≥30×109/L(B-ALL)的6例患者首次诱导CR率为33%,两者差异(P=0.018)有统计学意义。3.生存率:儿童方案组:除外3例采用Allo-HSCT患者,其余成人ALL采用儿童方案规律化疗,其中15例(47%)存活,17例(53%)死亡,中位生存期38(0.5-57)月,3年OS率为60%,3年DFS率为53%。成人方案组:20例成人ALL采用成人方案规律化疗,其中6例(30%)存活,14例(70%)死亡,中位生存期19.5(1-45)月,3年OS率为30%,3年DFS率为30%。两组3年OS率差异有统计学意义(P=0.023),3年DFS差异无统计学意义(P=0.102)。结论:对初发成人ALL的治疗,儿童方案与成人方案对比,诱导缓解率、3年OS率及DFS率均明显增高,对年龄大于35岁、发病时WBC≥30×109/L患者的诱导缓解率较成人方案高。因此,治疗成人ALL,儿童方案疗效优于成人方案。成人对儿童化疗方案耐受较好,但对化疗毒副反应较儿童大,治疗中应注意强化预防感染。
[Abstract]:Objective: to retrospectively analyze the clinical data and therapeutic effect of acute lymphoblastic leukemia (ALL) in the Department of Hematology, Department of Hematology, second affiliated Hospital of Dalian Medical University. Methods: from January 18th 2011 to January 18th 2014, the clinical data of 35 children's and 20 newly diagnosed adult ALL patients who were treated with the second affiliated Hospital of Dalian Medical University were collected, and the clinical data of the patients were analyzed. These include age, sex, date of diagnosis, diagnosis of disease, incidence, recording of blood routine at first visit, proportion of bone marrow primordial cells, chromosome analysis, immunological typing and fusion gene. To determine each patient's risk stratification score, treatment plan, first induced remission time to CR(complete remission. to observe the side effects of chemotherapy drugs, infection, survival time, disease-free survival. Cause of death and so on. Using SPSS16.0 statistical software analysis results. P0.05 has statistical significance. Results: 1. General characteristics: children program group: 35 patients into the group, Male: female: 1: 1.2, median age: 3316-56). 18 cases of risk group, 17 cases of high risk group, 17 cases of high risk group, 32 cases with 91D T-ALL, 3 cases with T-ALL. Male: female 1: 1.2, median age: 33.5- (15-57) years old. 15 cases in the risk group and 5 cases in the high risk group, 5 cases in the high risk group, 5 cases in the high risk group, 16 cases in the high risk group, 16 cases in the high risk group, and 20 cases in 20 cases. 2. Curative effect: children's program group, 35 adults, ALL, the CR rate of the first induction chemotherapy in children's regimen 91nRruremission.The response rate is 9, and the time taken to reach CR1 is 4 weeks. Except for 3 cases with allogeneic hematopoietic stem cell transplantation (Allo-HSCT), Of the other 32 cases, 14 cases had recurrence. In the adult program group, 20 adult patients with ALL received the first induction chemotherapy with adult regimen, the CR rate was 70% and NR rate was 30%. The patients who had reached CR1 for 4 weeks accounted for 71% of them, and more than 4 weeks for 29 cases (13 cases). The CR rates of the first induction chemotherapy group and the adult group were 91% and 70, respectively. There was a significant difference between the two groups. The CR rate of 16 patients with age 鈮，

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