Tavernier E, Boiron J-M, Huguet F, Bradstock K, Vey N, Kovacsovics T, Delannoy A, Fegueux N, Fenaux P, Stamatoullas A, Tournilhac O, Buzyn A, Reman O, Charrin C, Boucheix C, Gabert J, Lhéritier V, Vernant J-P, Dombret H, Thomas X
Hôpital Nord, Saint-Etienne, France.
Leukemia. 2007 Sep;21(9):1907-14. doi: 10.1038/sj.leu.2404824. Epub 2007 Jul 5.
Fifty-four percent of adults with acute lymphoblastic leukemia (ALL) who entered the LALA-94 trial experienced a first relapse. We examined the outcome of these 421 adult patients. One hundred and eighty-seven patients (44%) achieved a second complete remission (CR). The median disease-free survival (DFS) was 5.2 months with a 5-year DFS at 12%. Factors predicting a better outcome after relapse were any transplant performed in second CR (P<0.0001), a first CR duration >1 year (P=0.04) and platelet level >100 x 10(9)/l at relapse (P=0.04). Risk groups defined at diagnosis and treatment received in first CR did not influence the outcome after relapse. The best results were obtained in a subset of patients who were eligible for allogeneic stem cell transplantation (SCT). Geno-identical allogeneic SCT was performed in 55 patients, and 3 patients received donor lymphocyte infusions. Forty-four transplantations were performed from an unrelated donor (of which four were cord blood). We conclude that most adult patients with recurring ALL could not be rescued using current available therapies, although allogeneic SCT remains the best therapeutic option.
参加LALA - 94试验的成年急性淋巴细胞白血病（ALL）患者中有54%经历了首次复发。我们研究了这421例成年患者的治疗结果。187例患者（44%）获得了第二次完全缓解（CR）。无病生存期（DFS）的中位数为5.2个月，5年DFS率为12%。复发后预后较好的预测因素包括在第二次CR时进行任何移植（P<0.0001）、首次CR持续时间>1年（P = 0.04）以及复发时血小板水平>100×10⁹/L（P = 0.04）。首次CR时确定的诊断和治疗风险组对复发后的预后没有影响。在符合异基因干细胞移植（SCT）条件的一部分患者中取得了最佳结果。55例患者进行了同基因异基因SCT，3例患者接受了供体淋巴细胞输注。44例移植来自无关供体（其中4例为脐血）。我们得出结论，尽管异基因SCT仍然是最佳治疗选择，但大多数复发的成年ALL患者无法通过目前可用的疗法得到挽救。
