成人早期前体T细胞急性淋巴细胞白血病的临床特征和预后分析
Characteristics and prognosis in adult patients with early T-cell precursor acute lymphoblastic leukemia
目的 分析成人早期前体T细胞急性淋巴细胞白血病(ETP-ALL)的临床、实验室特征及预后情况.方法 回顾性分析2009年1月至2017年3月确诊的13例ETP-ALL患者的临床和实验室资料,并与非ETP的T-ALL (Non-ETP ALL)患者进行比较.结果 75例T-ALL患者中,符合ETP-ALL诊断标准患者13例(17.3%),其中男10例(76.9%),女3例(23.1%),诊断时中位年龄为35(15~49)岁.与62例Non-ETP ALL患者相比,ETP-ALL患者的WBC、LDH、外周血原始细胞计数较低,胸腺肿物发生率更低,PLT水平更高.ETP-ALL与Non-ETP ALL患者1个疗程CR率分别为33.3%和90.1%,差异具有统计学意义(x2=26.521,P<0.001).两组患者的中位总生存(OS)时间分别为11.33 (95%CI0~ 28.46)和25.69(95% CI 11.98~ 39.41)个月,3年OS率分别为41.7%和40.7%(P=0.699).两组患者的中位无事件生存(EFS)时间分别为1,51(95% CI 1.23~ 1.79)和21.36(95% CI 4.67~ 38.04)个月,3年EFS率分别为16.7%和39.5%(P=0.002),3年无复发生存(RFS)率分别为53.0%和52.0%(P=0.797).多因素分析显示是否为ETP-ALL并不是影响T-ALL总体预后的独立因素,而是否合并中枢神经系统白血病、是否行异基因造血干细胞移植为T-ALL的独立预后因素.结论 该研究为国内首次关于成人ETP-ALL特征以及预后分析的报道.在成人T-ALL患者中,ETP-ALL占17.3%,具有起病时肿瘤负荷不高,但1个疗程化疗CR率较低的临床特点.异基因造血干细胞移植有可能克服ETP-ALL的不良预后.
更多Objective To analyze the clinical,laboratory characteristics and prognosis of adult early T-cell precursor acute lymphoblastic leukemia (ETP-ALL).Methods The clinical data of 13 adult ETP-ALL patients from January 2009 to March 2017 were retrospectively analyzed and compared with non-ETP ALL patients.Results 13 ETP-ALL patients (17.3%) were identified in 75 adult T-ALL patients,the median age of the patients was 35 years old (15 to 49 years) and 10 patients were male (76.9%).ETP-ALL patients had lower WBC count,LDH level,blasts in peripheral blood,lower incidence of thymic mass and higher PLT count compared to non-ETP ALL patients.The CR rate after one course induction chemotherapy for ETP-ALL and non-ETP ALL patients was 33.3% and 90.1%,respectively (x2 =26.521,P < 0.001).The median overall survival(OS) was 11.33 (95%CI 0-28.46) and 25.69 (95%CI 11.98-39.41)months,respectively.The 3-year OS was 41.7% and 40.7%,respectively (P=0.699).The median event free survival (EFS) was 1.51 (95%CI 1.23-1.79) and 21.36 (95%CI 4.67-38.04) months,respectively.The 3-year EFS was 16.7% and 39.5%,respectively (P=0.002).The 3-year relapse free survival (RFS) was 53.0% and 52.0%,respectively (P=0.797).Multivariate analysis revealed that CNSL and allo-HSCT were independent risk factors affecting OS of T-ALL and ETP-ALL didn't affect the prognosis of T-ALL.Conclusion To our knowledge,this study is the first report on characteristics and prognosis of adult ETP-ALL patients in China.At total of 13 T-ALL patients (17.3%) were classified as having ETP-ALL.These patients had a lower leukemia burden and lower CR rate after one course induction compared to non-ETP ALL patients.Allo-HSCT can improve the prognosis of ETP-ALL.
More- 浏览:1097
- 被引:16
- 下载:771
相似文献
- 中文期刊
- 外文期刊
- 学位论文
- 会议论文