Objective: To evaluate the results of autologous hematopoietic stem cell transplantation (auto-HSCT) in adults with Philadelphia chromosome-negative acute lymphoblastic leukemia (Ph-ALL).
Methods: From January 2000 to December 2007, the clinical data of auto-HSCT in adults Ph-ALL with complete remession (CR) 1 according to BDHALL2000/02 protocol were analyzed.
Results: A total of 56 patients were enrolled and the probabilities of standard risk, intermediated risk and high-risk group were 41.1%, 33.9%, and 25.0%, respectively. After a median follow-up of 75 months (range 7-177 months), the 5-year overall survival (OS), events free survival (EFS) and relapse free survival (RFS) were (51.8 ± 6.7)%, (51.8 ± 6.7)%, and (60.5 ± 6.9)%, respectively. And the 5-year accumulative relapse rate was (39.1 ± 6.9)%. The 5-year OS of standard risk, intermediate risk, high-risk group were (60.9 ± 10.2)%, (52.6 ± 11.5)%, and (35.7 ± 2.8)%, respectively. The 5-year RFS among three groups were (68.3 ± 9.9)%, (62.5 ± 12.1)%, and (44.9 ± 14.1)%, respectively. The 5-year EFS among three groups were (60.9 ± 10.2)%, (52.6 ± 11.5)%, and (35.7 ± 12.8)%, respectively. The 5-year accumulative relapse rate among three groups were (31.7 ± 9.9)%, (37.5 ± 12.1)%, and (55.1 ± 14.1)%, respectively. There was no statistical significance of any survival rates between standard and intermediate risk groups, just as intermediate and high-risk groups. The OS and EFS in standard risk group were superior to those in high-risk group (P=0.040 and P=0.029, respectively), while there was no statistical significance of RFS and accumulative relapse rate between the two groups. The clinical factors listed below did not influenced the prognosis in the univariate analysis (P>0.05), including more than 5 weeks reaching to CR, WBC count at diagnosis, different immunophenotype (T or B cells), myeloid antigen expression, hyperdiploid chromosome karyotype, complex chromosome abnormality, conditioning regimen with or without TBI, duration between transplantation and diagnosis.
Conclusion: Ph-ALL adults could achieve a satisfactory CR and better survial according to BDHALL2000/02 protocol followed by auto-HSCT, especially for the standard or intermediate risk group, and no-donors high-risk patients.
目的: 探讨自体造血干细胞移植（AHSCT）治疗年轻成人Ph−急性淋巴细胞白血病（ALL）的疗效。
方法: 纳入56例于2000年1月至2007年12月接受BDHALL2000/02方案治疗并于CR1期行AHSCT的成人（15~60岁）Ph−ALL患者，对其进行生存和预后影响因素分析。
结果: 56例患者中标危、中危和高危者分别为23例（41.1%）、19例（33.9%）和14例（25.0%）。中位随访75(7~177）个月。5年总生存（OS）、无事件生存（EFS）、无复发生存（RFS）、复发率分别为（51.8±6.7）%、（51.8± 6.7）%、（60.5±6.9）%、（39.1±6.9）%。标、中、高危组患者的5年OS率分别为（60.9±10.2）%、（52.6± 11.5）％和（35.7±12.8）%，EFS率分别为（60.9±10.2）%、（52.6±11.5）％和（35.7±12.8）%，RFS率分别为（68.3±9.9）%、（62.5±12.1）％和（44.9±14.1）%，复发率分别为（31.7±9.9）%、（37.5±12.1）％和（55.1± 14.1）%。标危和中危组、中危和高危组患者的上述指标比较差异均无统计学意义（P值均>0.05）；标危组患者的OS、EFS率高于高危组（P值分别为0.040和0.029），而RFS和复发率差异则无统计学意义（P值均>0.05）。对年龄≥35岁、完全缓解时间超过5周、初诊白细胞水平、免疫表型（B/T）、伴髓系表达、超二倍体染色体核型、复杂核型、完全缓解至AHSCT间隔时间、预处理方案是否包含TBI等进行单因素分析，均未显示对预后存在影响（P值均>0.05）。
结论: 年轻成人Ph−ALL患者经BDHALL2000/02方案治疗可以获得较高的缓解率，缓解后给予早期序贯强化/巩固治疗后进行AHSCT疗效显著，是标危、中危组及无合适供者的高危组患者的合适选择。