Jin Feng-yan, Zou De-hui, Wang Guo-rong, Xu Yan, Feng Si-zhou, Zhao Yao-zhong, Han Ming-zhe, Yan Wen-wei, Qiu Lu-gui
Institute of Hematology and Blood Diseases Hospital, CAMS and PUMC, Tianjin 300020, China.
Zhonghua Xue Ye Xue Za Zhi. 2005 Nov;26(11):645-8.
To evaluate the effectiveness of chemotherapy (CT) and autologous hematopoietic stem cell transplantation (ASCT) as post-remission treatment for adult acute lymphoblastic leukemia (AL) patients.
Seventy-four ALL patients achieved first complete remission (CR(1)) with induction therapy, and then received early-stage sequential intensive consolidation chemotherapy. After that, 40 patients received chemotherapy (CT group) and 34 received ASCT (ASCT group) as post-remission treatment. The median follow-up was 20.5 months. The rates of leukemia free survival (LFS), overall survival (OS) and relapse were compared between the two groups.
(1) The median LFS and OS were 14.0 and 20.6 months respectively for CT group and both were more than 53.5 months for ASCT groups. (2) Relapse occurred in 28 patients (70%) in CT group in a median time of 8.5 months (range, 1-72 months) and 20 of them (71.43%) relapsed within 1 year. Eleven patients (32.35%) relapsed in ASCT group, in a median time of 6 (2-30) months after transplantation. (3) There was no statistic difference in LFS, OS and relapse rate at 1 year between CT and ASCT groups (P > 0.05), whereas both LFS and OS at 3 and 5 years for ASCT group were significantly better than those for CT group (P < 0.05). Relapse rate for ASCT group was lower than that for CT group. (4) Higher LFS and OS and lower relapse rate were found for those who received monoclonal antibody purged autografts followed by immunotherapy and (or) maintenance therapy after ASCT (P < 0.05).
Early sequential intensive consolidation chemotherapy followed by auto-HSCT could significantly reduce late relapse rate for adult ALL patients, and those received ex vivo purged autografts and immunotherapy and (or) maintenance therapy after ASCT have lower late relapse rate and superior survival.
评估化疗（CT）和自体造血干细胞移植（ASCT）作为成人急性淋巴细胞白血病（AL）患者缓解后治疗的有效性。
74例ALL患者通过诱导治疗首次达到完全缓解（CR(1)），随后接受早期序贯强化巩固化疗。之后，40例患者接受化疗（CT组），34例接受ASCT（ASCT组）作为缓解后治疗。中位随访时间为20.5个月。比较两组的无白血病生存率（LFS）、总生存率（OS）和复发率。
（1）CT组的中位LFS和OS分别为14.0个月和20.6个月，而ASCT组两者均超过53.5个月。（2）CT组28例患者（70%）复发，中位复发时间为8.5个月（范围1 - 72个月），其中20例（71.43%）在1年内复发。ASCT组11例患者（32.35%）复发，移植后中位复发时间为6（2 - 30）个月。（3）CT组和ASCT组1年时的LFS、OS和复发率无统计学差异（P > 0.05），而ASCT组3年和5年时的LFS和OS均显著优于CT组（P < 0.05）。ASCT组的复发率低于CT组。（4）接受单克隆抗体净化自体移植并在ASCT后接受免疫治疗和（或）维持治疗的患者LFS和OS更高，复发率更低（P < 0.05）。
早期序贯强化巩固化疗后行自体造血干细胞移植可显著降低成人ALL患者的晚期复发率，接受体外净化自体移植并在ASCT后接受免疫治疗和（或）维持治疗的患者晚期复发率更低，生存率更高。
