O'Brien Susan, Thomas Deborah, Ravandi Farhad, Faderl Stefan, Cortes Jorge, Borthakur Gautum, Pierce Sherry, Garcia-Manero Guillermo, Kantarjian Hagop M
Department of Leukemia, The University of Texas M. D. Anderson Cancer Center, Houston, Texas 77030, USA.
Cancer. 2008 Dec 1;113(11):3186-91. doi: 10.1002/cncr.23919.
The outcome of adults with acute lymphocytic leukemia (ALL) who undergo second salvage therapy has been characterized poorly. This is important with regard to investigational approaches aimed at helping this subset of patients. The objectives of the current study were to predict outcomes and determine the prognostic factors associated with second salvage therapy in patients with ALL.
In this study, 288 patients were analyzed who received second salvage therapy for ALL at the authors' institution.
Overall, 53 patients (18%) achieved a complete response (CR). The median remission duration was 7 months and the median survival was 3 months. In multivariate analysis, prognostic factors that were associated independently with achieving CR were duration of first CR and platelet count. Patients with a first CR <36 months and platelet counts <50 x 10(9)/L had an expected CR rate of 7%. In multivariate analysis, prognostic factors that were associated independently with survival were duration of first CR, percentage bone marrow blasts, platelet count, and albumin level. The expected 12-month survival rates for patients with 0 or 1, 2, 3, or 4 adverse factors were 33%, 14%, 8%, and 0%, respectively. A repeat multivariate analysis using landmark assessment at 6 weeks selected achievement of CR as adding significantly to the survival benefit (P = .0001; hazard ratio, 0.51). Only 22 patients (8%) were able to undergo allogeneic stem cell transplantation as second salvage therapy, and their 1-year survival rate was 18%.
The outcome of adults with ALL undergoing second salvage therapy is poor. Novel effective therapies against ALL are needed in this subset of patients.
接受二次挽救治疗的成年急性淋巴细胞白血病（ALL）患者的预后情况一直未得到充分描述。这对于旨在帮助这一亚组患者的研究方法而言至关重要。本研究的目的是预测接受ALL二次挽救治疗患者的预后，并确定与之相关的预后因素。
本研究分析了在作者所在机构接受ALL二次挽救治疗的288例患者。
总体而言，53例患者（18%）达到完全缓解（CR）。中位缓解持续时间为7个月，中位生存期为3个月。多因素分析显示，与达到CR独立相关的预后因素是首次CR持续时间和血小板计数。首次CR<36个月且血小板计数<50×10⁹/L的患者预期CR率为7%。多因素分析显示，与生存独立相关的预后因素是首次CR持续时间、骨髓原始细胞百分比、血小板计数和白蛋白水平。具有0或1个、2个、3个或4个不良因素的患者预期12个月生存率分别为33%、14%、8%和0%。使用6周时的标志性评估进行的重复多因素分析选择达到CR作为显著增加生存获益的因素（P = 0.0001；风险比，0.51）。只有22例患者（8%）能够接受异基因干细胞移植作为二次挽救治疗，其1年生存率为18%。
接受ALL二次挽救治疗的成年患者预后较差。这一亚组患者需要新的有效的ALL治疗方法。
