Faderl Stefan, Thall Peter F, Kantarjian Hagop M, Estrov Zeev
Department of Leukaemia, The University of Texas M. D. Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX 77030, USA.
Br J Haematol. 2002 Jun;117(4):869-74. doi: 10.1046/j.1365-2141.2002.03506.x.
Survival in acute leukaemia depends on the achievement of complete remission (CR). However, CR is not a clear-cut phenomenon and certain variables of its definition could more accurately characterize the quality of the remission. Because platelet recovery > 100 x 10(9)/l is an essential component of CR in acute leukaemia, we hypothesized that time to platelet recovery (TPR) might be predictive of overall survival (OS) or disease-free survival (DFS) in acute lymphoblastic leukaemia (ALL). We analysed TPR in 249 patients with ALL who entered CR after one course of induction chemotherapy and correlated TPR with DFS and OS. TPR was significantly associated with both DFS and OS if it occurred within a maximum of about 60 d from start of therapy. Furthermore, during that time period, the relative risk of death increased with increasing TPR. Although presence of the Philadelphia chromosome was the single most important adverse feature at diagnosis, the effect of TPR on survival continued to be significant within this patient subgroup. This effect was so pronounced that Philadelphia chromosome-positive patients with a TPR of 12 d had a better outcome than Philadelphia chromosome-negative patients with a TPR of 48 d. Thus, a short TPR seems to be able to override adverse characteristics in the outcome of ALL patients treated with chemotherapy. We conclude that a quicker TPR predicts longer DFS and OS in patients with ALL. As platelet counts are obtained almost daily in patients undergoing chemotherapy, TPR can readily be utilized to assess the prognosis of these patients.
急性白血病的生存取决于完全缓解（CR）的实现。然而，CR并非一种明确的现象，其定义中的某些变量可以更准确地描述缓解的质量。由于血小板恢复>100×10⁹/L是急性白血病CR的一个重要组成部分，我们推测血小板恢复时间（TPR）可能是急性淋巴细胞白血病（ALL）总生存期（OS）或无病生存期（DFS）的预测指标。我们分析了249例接受一个疗程诱导化疗后进入CR的ALL患者的TPR，并将TPR与DFS和OS进行相关性分析。如果TPR在治疗开始后最多约60天内出现，则其与DFS和OS均显著相关。此外，在该时间段内，死亡相对风险随TPR增加而升高。虽然费城染色体的存在是诊断时最重要的单一不良特征，但在该患者亚组中，TPR对生存的影响仍然显著。这种影响非常明显，以至于TPR为12天的费城染色体阳性患者比TPR为48天的费城染色体阴性患者预后更好。因此，较短的TPR似乎能够克服接受化疗的ALL患者预后中的不良特征。我们得出结论，更快的TPR预示着ALL患者更长的DFS和OS。由于接受化疗的患者几乎每天都进行血小板计数，TPR可很容易地用于评估这些患者的预后。
