Servei d'Hematologia Clínica, Institut Català d'Oncologia, Hospital Germans Trias i Pujol, 08916 Badalona, Barcelona, Spain.
Haematologica. 2010 Apr;95(4):589-96. doi: 10.3324/haematol.2009.014274. Epub 2010 Feb 9.
About one half of adults with acute lymphoblastic leukemia are not cured of the disease and ultimately die. The objective of this study was to explore the factors influencing the outcome of adult patients with relapsed acute lymphoblastic leukemia.
We analyzed the characteristics, the outcome and the prognostic factors for survival after first relapse in a series of 263 adult patients with acute lymphoblastic leukemia (excluding those with mature B-cell acute lymphoblastic leukemia) prospectively enrolled in four consecutive risk-adapted PETHEMA trials.
The median overall survival after relapse was 4.5 months (95% CI, 4-5 months) with a 5-year overall survival of 10% (95% CI, 8%-12%); 45% of patients receiving intensive second-line treatment achieved a second complete remission and 22% (95% CI, 14%-30%) of them remained disease free at 5 years. Factors predicting a good outcome after rescue therapy were age less than 30 years (2-year overall survival of 21% versus 10% for those over 30 years old; P<0.022) and a first remission lasting more than 2 years (2-year overall survival of 36% versus 17% among those with a shorter first remission; P<0.001). Patients under 30 years old whose first complete remission lasted longer than 2 years had a 5-year overall survival of 38% (95% CI, 23%-53%) and a 5-year disease-free survival of 53% (95% CI, 34%-72%).
The prognosis of adult patients with acute lymphoblastic leukemia who relapse is poor. Those aged less than 30 years with a first complete remission lasting longer than 2 years have reasonable possibilities of becoming long-term survivors while patients over this age or those who relapse early cannot be successfully rescued using the therapies currently available.
约有一半的成人急性淋巴细胞白血病患者无法治愈疾病，最终死亡。本研究的目的是探讨影响成人复发急性淋巴细胞白血病患者预后的因素。
我们对 263 例成人急性淋巴细胞白血病（不包括成熟 B 细胞急性淋巴细胞白血病）患者进行了前瞻性分析，这些患者均在连续四项风险适应性 PETHEMA 试验中入组。分析其特征、首次复发后的结果和生存预后因素。
复发后的中位总生存期为 4.5 个月（95%CI，4-5 个月），5 年总生存率为 10%（95%CI，8%-12%）；45%接受强化二线治疗的患者获得第二次完全缓解，22%（95%CI，14%-30%）的患者在 5 年内无疾病复发。挽救性治疗后预后良好的预测因素包括年龄<30 岁（2 年总生存率为 21%，而>30 岁的患者为 10%；P<0.022）和首次缓解持续时间超过 2 年（2 年总生存率为 36%，而首次缓解持续时间较短的患者为 17%；P<0.001）。年龄<30 岁且首次完全缓解持续时间超过 2 年的患者，5 年总生存率为 38%（95%CI，23%-53%），5 年无病生存率为 53%（95%CI，34%-72%）。
成人急性淋巴细胞白血病患者复发后的预后较差。年龄<30 岁且首次完全缓解持续时间超过 2 年的患者有成为长期幸存者的合理可能性，而年龄超过此年龄或早期复发的患者不能通过目前可用的治疗成功挽救。
