VPD(L)方案治疗成人急性淋巴细胞白血病的疗效：预后因素分析

Treatment outcome of adult acute lymphocytic leukemia with VPD(L) regimen: analysis of prognostic factors.

作者信息

Park Sook-Ryun, Kim Jee Hyun, Kim Do Yeun, Lee Sehoon, Lee Sang-Yoon, Choi In Sil, Yoon Sung-Soo, Park Seonyang, Kim Byuoung-Gook, Kim Noe Kyoung

机构信息

Department of Internal Medicine, Seoul National University College of Medicine, 28, Yongon-dong, Chongno-gu, Seoul 110-744, Korea.

出版信息

Korean J Intern Med. 2003 Mar;18(1):21-8. doi: 10.3904/kjim.2003.18.1.21.

DOI:10.3904/kjim.2003.18.1.21

PMID:12760264

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC4531597/

Abstract

BACKGROUND

Because of the relative paucity of data regarding the clinical outcome in adult patients with acute lymphocytic leukemia (ALL) in Korea, we analyzed clinical courses in adult ALL patients treated with VPD (L) regimen (vincristine, prednisolone, daunorubicin, L-asparaginase) at the Seoul National University Hospital, and evaluated prognostic factors influencing the outcome.

METHODS

Patients with ALL newly diagnosed between October 1994 and June 2000 at our hospital were analyzed retrospectively. Fifty-three patients were evaluable. Induction chemotherapy consisted of VPD with (46 cases) or without L-asparaginase (7 cases). After complete remission (CR), consolidation therapy, CNS prophylaxis and maintenance chemotherapy were administered.

RESULTS

Ages ranged from 16 to 67 (median 30). CR rate was 86.8% (46/53) and no significant prognostic factor was found for the CR rate. With a median follow-up time of 27.2 months (range 12.9-83.0 months) in living patients, the median overall survival (OS) for all cases was 16.7 months (13.4-20.1 months, 95% C.I.) and the estimated 4-year OS rate was 25.4% +/- 8.9%. The median relapse-free survival (RFS) was 12.2 months (8.4-16.0 months, 95% C.I.), and 3-year RFS rate was 29.9% +/- 10.2%. Poor prognostic factors for OS were Ph chromosome (p = 0.005) and T-cell immunophenotype (p = 0.03). For RFS they were Ph chromosome (p = 0.01) and the presence of a mediastinal mass (p = 0.03).

CONCLUSION

Despite an initial excellent response to the VPD (L) regimen, newer therapeutic strategies, including more intensive postremission therapies, are urgently needed because of the high relapse rate. Future therapeutic approaches need to be stratified according to several prognostic factors.

摘要

背景

由于韩国关于成年急性淋巴细胞白血病（ALL）患者临床结局的数据相对较少，我们分析了首尔国立大学医院接受VPD（L）方案（长春新碱、泼尼松龙、柔红霉素、L-天冬酰胺酶）治疗的成年ALL患者的临床病程，并评估了影响结局的预后因素。

方法

对1994年10月至2000年6月期间在我院新诊断的ALL患者进行回顾性分析。53例患者可评估。诱导化疗采用含（46例）或不含L-天冬酰胺酶（7例）的VPD方案。完全缓解（CR）后，进行巩固治疗、中枢神经系统预防和维持化疗。

结果

年龄范围为16至67岁（中位年龄30岁）。CR率为86.8%（46/53），未发现影响CR率的显著预后因素。存活患者的中位随访时间为27.2个月（范围12.9 - 83.0个月），所有病例的中位总生存期（OS）为16.7个月（13.4 - 20.1个月，95%置信区间），估计4年OS率为25.4%±8.9%。中位无复发生存期（RFS）为12.2个月（8.4 - 16.0个月，95%置信区间），3年RFS率为29.9%±10.2%。OS的不良预后因素为Ph染色体（p = 0.005）和T细胞免疫表型（p = 0.03）。对于RFS，不良预后因素为Ph染色体（p = 0.01）和纵隔肿块的存在（p = 0.03）。