Xue Sheng-Li, Wu De-Pei, Sun Ai-Ning, Tang Xiao-Wen
Department of Hematology, the First Affiliated Hospital of Soochow University, Suzhou, China.
Am J Hematol. 2008 Feb;83(2):167-70. doi: 10.1002/ajh.21066.
Patients with either relapsed or refractory T-cell acute lymphocytic leukemia (T-ALL) are candidates for allogeneic hematopoietic stem cell transplantation (allo-HSCT). Achieving complete remission (CR) in these patients is difficult but crucial for the success of allo-HSCT. In this study, we examined 6 relapsed or refractory T-ALL patients. In the patient group, 4 were male and 2 were female, with ages ranging from 15 to 57 years (median=29 years). All 6 patients presented with the nonmature T-ALL phenotype. Cytogenetically, only one had an i(7q) anomaly, whereas the remaining 5 cases had normal karyotypes. One of these patients had the MLL/AF9 fusion transcript, as shown by molecular study. After initial remission-induction therapy, two patients achieved CR, one showed a partial remission, and all relapsed soon. The other 3 cases failed the therapy. The CAG regimen (cytosine arabinoside 10 mg/m(2) subcutaneously every 12 hr, day 1-14; aclarubicin 5-7 mg/m(2) intravenously daily, day 1-8; and concurrent use of G-CSF 200 microg/m(2)/day subcutaneously) was devised originally for the treatment of relapsed acute myelogenous leukemia. After CAG therapy, all the T-ALL patients in our study achieved CR, indicating that the CAG regimen is beneficial to the treatment of relapsed or refractory T-ALL. The efficacy of CR-induction in T-ALL patients and the adverse effects of the CAG regimen need to be further studied.
复发或难治性T细胞急性淋巴细胞白血病（T-ALL）患者是异基因造血干细胞移植（allo-HSCT）的候选对象。使这些患者实现完全缓解（CR）虽困难，但对allo-HSCT的成功至关重要。在本研究中，我们检查了6例复发或难治性T-ALL患者。患者组中，4例为男性，2例为女性，年龄范围为15至57岁（中位数=29岁）。所有6例患者均表现为未成熟T-ALL表型。细胞遗传学方面，仅1例有i(7q)异常，其余5例核型正常。分子研究显示，其中1例患者有MLL/AF9融合转录本。初始缓解诱导治疗后，2例患者实现CR，1例部分缓解，且均很快复发。另外3例治疗失败。CAG方案（阿糖胞苷10 mg/m²皮下注射，每12小时1次，第1 - 14天；阿柔比星5 - 7 mg/m²静脉注射，每日1次，第1 - 8天；同时皮下注射G-CSF 200 μg/m²/天）最初是为治疗复发的急性髓系白血病而设计。CAG治疗后，我们研究中的所有T-ALL患者均实现CR，表明CAG方案对复发或难治性T-ALL的治疗有益。T-ALL患者CR诱导的疗效及CAG方案的不良反应有待进一步研究。
