目的 通过成人急性淋巴细胞白血病(ALL)诊治、预后因素的回顾分析,总结临床经验,以提高诊治水平.方法 回顾性分析总结1990至2010年51例成人急性淋巴细胞白血病的临床资料:符合FAB、部分符合FCM、MIC、MICM诊断,高危患者32/51例(62.7%).采用诱导缓解方案VD(或M)D、VD(或M)LD、VD(或M)CAD,1例老年B-ALL患者使用利妥昔单抗(Rituximab)联合VP诱导,巩固治疗方案如:大剂量甲氨蝶呤(HD-MTX)、大剂量阿糖胞苷(HD-Arac)、含依托泊苷(VP16)、米托蒽醌(M)等方案;维持治疗采用巯基嘌呤(6 Mp)、MTX、强的松(Pred),中枢神经系统白血病(CNSL)预防及治疗采用鞘内注射、全身化疗,5例ALL患者巩固治疗采用半身交替照射(HBI)1次,4例完全缓解后在外院进行异基因造血于细胞移植(Allo-HSCT).结果 36/51例(70.6%)获CR,全组中位随访时间2.2年.36例CR患者3年复发率66.7%,51例患者3年总生存率(OS)和无病生存率(DFS)分别为29.4%和19.6%,5年总生存率(OS)无病生存率(DFS)分别为17.6%和13.7%,10年无病生存(临床治愈)为3例5.9%,死亡主要原因为感染以及颅内出血.结论 ALL单纯化疗复发率高,应根据患者特点确定个体化治疗,Allo-HSCT和HBI对长期生存起关键作用.%Objective To observe adult ALL treatment, prognosis,to summarize the clinical experience, and eventually improve the treatment level. Methods 51 patients with adult ALL from 1993 to 2010 were studied retrospectively, including befitting FAB diagnostic,party befitting FCM, MIC, MICM ,first induction regimen :high- dose methotrexate, high- dose cytarabine( including VP16 ), mitoxantrone regimen and so on, for consolidation treatment:6 - Mp, MTX, Pred, for maintenance treatment; rituximab treatment; the prevention and treatment central nervous system leukemia (CNSL); five patients with HBI; four patieuts with AHOHSCT. Results 36/51 patients (70.6％ ) entered CR. Median follow - up time2.2 - year,36 CR patients 3 - year recurrence rate 66.7％ ,3 - year overall survival(OS) and disease free survival(DFS) of 51 patients were29.4％ and 19.6％ respectively,5 - year OS and DFS were17.6％ and13.7％ respectively, 10 - year DFS were 3 patients 5.9％ ,The main cause of death were ? Infection and intracranial hemorrhage. Conclusion Adult ALL reoccurrence rate is high only depend on chemotherapy treatment, should be individualized based on patient characteristics, AlloHSCT and HBI play important role in long -term survival.
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