伊马替尼联合化疗治疗成年人费城染色体阳性急性淋巴细胞白血病效果分析

摘要

Objective To investigate the clinical effects of imatinib combined with chemotherapy in adults with Philadelphia-positive acute lymphoblastic leukemia (Ph + ALL). Methods A total of 35 newly diagnosed Ph+ ALL patients from June 2012 to January 2016 in the First Hospital of China Medical University were enrolled. The patients were divided into 21 cases (combined chemotherapy group) and 14 cases (chemotherapy alone group). There were 4 patients in combined chemotherapy group who underwent hematopoietic stem cell transplantation (HSCT) after the first complete remission (CR). The parameters including blood routine, bone marrow morphology, immunoassay, chromosome and fusion genes were detected regularly for efficacy assessment. Results CR rate after the first induction therapy was 76％ (16/21) in combined chemotherapy group and 36％ (5/14) in the chemotherapy alone group, and there was a significant difference of both groups (χ 2 = 5.734, P = 0.033). The median overall survival (OS) time for patients in combined chemotherapy group and chemotherapy alone group were 14 months (2-18 months) and 5 months (0.33-10 months) respectively (U = 12.0, P = 0.007). And the median disease-free survival (DFS) time were 8 months (0-15 months) and 2 months (0-6 months), respectively (U = 12.5, P = 0.007). The median OS and DFS time for transplant patients were 26 months (22-39 months) and 22 months (17-36 months) respectively. Conclusions Imatinib combined chemotherapy can increase CR rate, DFS and OS time for Ph+ ALL patients during the induction therapy, which can gain more chance to receive HSCT. The patients who could receive HSCT as soon as possible after CR1 could get longer survival time.%目的 分析伊马替尼联合化疗治疗成年人费城染色体阳性(Ph+)急性淋巴细胞白血病(ALL)的临床疗效.方法 收集2012年6月至2016年1月就诊于中国医科大学附属第一医院的成年Ph+ALL患者35例,其中联合化疗组21例,单纯化疗组14例.定期监测血常规、骨髓细胞形态学、免疫分析、染色体及融合基因等,评估疗效.联合化疗组4例患者第1次完全缓解(CR1)后行造血干细胞移植治疗.结果 联合化疗组诱导治疗后完全缓解(CR)率为76％(16/21),单纯化疗组为36％(5/14),两组比较差异有统计学意义(χ2=5.734,P=0.033).联合化疗组(除移植患者)中位总生存(OS)时间为14个月(2～18个月),单纯化疗组5个月(0.33～10个月),两组比较差异有统计学意义(U=12.0,P=0.007).联合化疗组中位无病生存(DFS)时间为8个月(0～15个月),单纯化疗组为2个月(0～6个月),两组比较差异有统计学意义(U=12.5,P=0.007).4例移植患者中位OS时间26个月(22～39个月),中位DFS时间22个月(17～36个月).结论 Ph+ALL患者诱导治疗期采用伊马替尼联合化疗可提高CR率,延长DFS及OS时间,为移植赢得时间与机会.CR1后有条件者及时行造血干细胞移植治疗可延长生存时间.