Objective: To explore the clinical characteristics of adult acute lymphoblastic leukemia (ALL), compare the efficacy of different induction regimens and analyze the prognostic factors.
Methods: Data of 149 adult ALL patients hospitalized in our institute between June 1998 and December 2005 were retrospectively reviewed. The results were analyzed with the SPSS11.5 software.
Results: 1) Out of 133 patients available immunophenotype data, 118 (88.7%) were B-ALL and 15 (11.3%) T-ALL. Cytogenetic analysis was performed in 105 patients, 40 cases (38.1%) of them had a normal karyotype and 65 (61.9%) chromosome aberrations. 2) 149 patients completed the VDCP, VDLP or VDCLP induction therapies (at least 4 weeks treatment for each), 140 (93.7%) of them achieved complete remission (CR) with the first course CR rates of 80.8%, 92.3% and 81.4% , respectively (P=0.618). CR rates in patients after the induction regimens with or without asparaginase were 95.5% versus 92.1% (P=0.566). With a median follow-up of 14.5 (1-75) months, the median disease free survival (DFS) was 12 (1-74) months and median overall survival (OS) 17.5 (1-97) months. DFS of the three regimen groups at 3 and 5 years were 18.5% and 14.8%, 24.7% and 9.9%, 39.5% and 39.5%, respectively (P=0.0066). 3) COX regression analysis showed that the age (over 40 years), white blood cell (WBC) count ( > 40 x 10(9)/L) , t(9;22) (q34;q11)-positive and less than 4 courses consolidation chemotherapy were the unfavorable prognostic factors.
Conclusions: Most adult ALL patients are B-ALL and karyotype have more changed. More than 90% patients can achieve CR with induction regimens consisting of 4 or 5 drugs. Induction regimens containing L-asparaginase may not affect the CR rate, but can improve DFS and OS. Age and WBC at diagnosis, presence of t(9;22) (q34;q11) and the courses of post-remission treatment are important prognostic factors.