Prognostic factors of adult Philadelphia chromosome negative acute lymphoblastic leukemia
OBJECTIVE: To analyze the prognostic factors in adult Philadelphia chromosome negative acute lymphoblastic leukaemia (Ph⁻ ALL).
METHODS: From December 1999 to December 2013, 353 consecutive hospitalized 18-65-year-old adult Ph⁻ ALL patients were retrospectively analyzed. Induction therapy was CODP±L-asparaginase (L-Asp) regimen, and consolidation therapy included CODP and high dose methotrexate or revised Hyper-CVAD A and B regimens for 8 cycles. 178 patients (50.4%) performed allo-HSCT after three to five cycles of consolidation treatment, and 172 patients didn't receive allo-HSCT. The median follow-up was 39.9 months (2.0 to 171.0 months) for the 184 survivors.
RESULTS: Three patients (0.85%) happened early death. CR rate after the first cycle of induction chemotherapy was 77.4% (271/350) among evaluated 350 patients. Overall CR rate was 92.9% (325/350). WBC ≥ 100.0 × 10⁹/L (P=0.010) and hepatomegaly/splenomegaly/lymphadenopathy (P=0.036) were independent adverse factors for overall CR. Among the 325 CR patients, 117 patients developed relapse, cumulative incidence of relapse (CIR) at 5 years was 43.2%, disease-free survival (DFS) and overall survival (OS) rates at 5 years were 44.7% and 45.6% respectively. Multivariate analysis showed that harboring central nervous system leukaemia (CNSL) at diagnose (P=0.004, P=0.002, P<0.001, respectively), induction regimen without L-Asp (P=0.023, P=0.009, P=0.004, respectively), time to CR more than 4 weeks (P=0.034, P=0.024, P=0.003, respectively), and non-allo-HSCT (P<0.001, P<0.001, P<0.001, respectively) were adverse factors of relapse, DFS and OS. In addition, high WBC count at diagnosis (≥ 30.0 × 10⁹/L for B lineage and ≥ 100.0 × 10⁹/L for T lineage) was poor factor of DFS (P=0.044). Based on the four adverse prognostic factors of DFS above mentioned (including WBC at diagnose, harboring CNSL at diagnose, induction regimen with or without L-Asp, time to CR more than 4 weeks), patients were grouped into low risk (no factor), intermediate risk (one factor), and high risk (at least two factors). Non-allo-HSCT and allo-HSCT had similar outcomes in low risk subgroup. Allo-HSCT significantly improved OS and DFS in intermediate and high risk subgroups rather than non-allo-HSCT (all P values < 0.001).
CONCLUSION: In adult Ph- ALL patients, high WBC count at diagnosis (≥ 30.0 × 10⁹/L for B lineage and ≥ 100.0 × 10⁹/L for T lineage), CNSL at diagnosis, induction regimen without L-Asp, time to CR more than 4 weeks and non-allo-HSCT were adverse prognostic factors. Allo-HSCT improved OS and DFS in patients with more than one of the first four adverse prognosis factors.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2015 |
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| Erschienen: |
2015 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:36 |
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| Enthalten in: |
Zhonghua xue ye xue za zhi = Zhonghua xueyexue zazhi - 36(2015), 1 vom: 17. Jan., Seite 10-5 |
| Sprache: |
Chinesisch |
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| Beteiligte Personen: |
Wang, Jing [VerfasserIn] |
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| Links: |
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| Themen: |
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| Anmerkungen: |
Date Completed 29.12.2015 Date Revised 11.11.2023 published: Print Citation Status MEDLINE |
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| doi: |
10.3760/cma.j.issn.0253-2727.2015.01.003 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM245847588 |
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| 100 | 1 | |a Wang, Jing |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a Prognostic factors of adult Philadelphia chromosome negative acute lymphoblastic leukemia |
| 264 | 1 | |c 2015 | |
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| 500 | |a Date Completed 29.12.2015 | ||
| 500 | |a Date Revised 11.11.2023 | ||
| 500 | |a published: Print | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a OBJECTIVE: To analyze the prognostic factors in adult Philadelphia chromosome negative acute lymphoblastic leukaemia (Ph⁻ ALL) | ||
| 520 | |a METHODS: From December 1999 to December 2013, 353 consecutive hospitalized 18-65-year-old adult Ph⁻ ALL patients were retrospectively analyzed. Induction therapy was CODP±L-asparaginase (L-Asp) regimen, and consolidation therapy included CODP and high dose methotrexate or revised Hyper-CVAD A and B regimens for 8 cycles. 178 patients (50.4%) performed allo-HSCT after three to five cycles of consolidation treatment, and 172 patients didn't receive allo-HSCT. The median follow-up was 39.9 months (2.0 to 171.0 months) for the 184 survivors | ||
| 520 | |a RESULTS: Three patients (0.85%) happened early death. CR rate after the first cycle of induction chemotherapy was 77.4% (271/350) among evaluated 350 patients. Overall CR rate was 92.9% (325/350). WBC ≥ 100.0 × 10⁹/L (P=0.010) and hepatomegaly/splenomegaly/lymphadenopathy (P=0.036) were independent adverse factors for overall CR. Among the 325 CR patients, 117 patients developed relapse, cumulative incidence of relapse (CIR) at 5 years was 43.2%, disease-free survival (DFS) and overall survival (OS) rates at 5 years were 44.7% and 45.6% respectively. Multivariate analysis showed that harboring central nervous system leukaemia (CNSL) at diagnose (P=0.004, P=0.002, P<0.001, respectively), induction regimen without L-Asp (P=0.023, P=0.009, P=0.004, respectively), time to CR more than 4 weeks (P=0.034, P=0.024, P=0.003, respectively), and non-allo-HSCT (P<0.001, P<0.001, P<0.001, respectively) were adverse factors of relapse, DFS and OS. In addition, high WBC count at diagnosis (≥ 30.0 × 10⁹/L for B lineage and ≥ 100.0 × 10⁹/L for T lineage) was poor factor of DFS (P=0.044). Based on the four adverse prognostic factors of DFS above mentioned (including WBC at diagnose, harboring CNSL at diagnose, induction regimen with or without L-Asp, time to CR more than 4 weeks), patients were grouped into low risk (no factor), intermediate risk (one factor), and high risk (at least two factors). Non-allo-HSCT and allo-HSCT had similar outcomes in low risk subgroup. Allo-HSCT significantly improved OS and DFS in intermediate and high risk subgroups rather than non-allo-HSCT (all P values < 0.001) | ||
| 520 | |a CONCLUSION: In adult Ph- ALL patients, high WBC count at diagnosis (≥ 30.0 × 10⁹/L for B lineage and ≥ 100.0 × 10⁹/L for T lineage), CNSL at diagnosis, induction regimen without L-Asp, time to CR more than 4 weeks and non-allo-HSCT were adverse prognostic factors. Allo-HSCT improved OS and DFS in patients with more than one of the first four adverse prognosis factors | ||
| 650 | 4 | |a Journal Article | |
| 700 | 1 | |a Huang, Xiaojun |e verfasserin |4 aut | |
| 700 | 1 | |a Jiang, Bin |e verfasserin |4 aut | |
| 700 | 1 | |a Jia, Jinsong |e verfasserin |4 aut | |
| 700 | 1 | |a Yang, Shenmiao |e verfasserin |4 aut | |
| 700 | 1 | |a Bao, Li |e verfasserin |4 aut | |
| 700 | 1 | |a Jiang, Hao |e verfasserin |4 aut | |
| 700 | 1 | |a Lu, Jin |e verfasserin |4 aut | |
| 700 | 1 | |a Zhu, Honghu |e verfasserin |4 aut | |
| 700 | 1 | |a Zhao, Ting |e verfasserin |4 aut | |
| 700 | 1 | |a Jiang, Qian |e verfasserin |4 aut | |
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