State Key Laboratory of Oncology in South China, Guangzhou, People's Republic of China.
Department of Hematologic Oncology, Cancer Center, Sun Yat-Sen University, 651 Dongfeng Road, Guangzhou, 510060, People's Republic of China.
Int J Hematol. 2011 Aug;94(2):163-168. doi: 10.1007/s12185-011-0891-y. Epub 2011 Jul 6.
Patients with newly diagnosed acute lymphoblastic leukemia (ALL) at a single institution were analyzed retrospectively. From 2006 to 2010, 47 patients were treated using the MRC UKALLXII/ECOG E2993 protocol. Prior to July 2005, 40 patients had been treated with the JALSG ALL 87 protocol. A complete remission (CR) rate of 91.5% was achieved with the E2993 protocol, which was not significantly higher than the 80% achieved using JALSG (P > 0.05). The median duration of CR in months was 19 for all patients treated with the MRC UKALLXII/ECOG E2993 protocol. Ph+ patients showed a median CR duration of 11.5 months, while Ph- patients had a significantly longer CR duration of 19 months (P = 0.019). Further, Ph- patients at standard risk (stratified on the basis of age and white blood cell count at diagnosis) had a CR duration of 21 months, which was significantly longer than the 12-month CR duration for the ten Ph- patients at high risk (P = 0.001). Significant differences were found in the 2-year event-free survival and overall survival rates between the MRC UKALLXII/ECOG E2993 and JALSG ALL 87 groups in the following three cohorts: all patients (P = 0.009 and 0.022, respectively), Ph- patients (P = 0.009 and 0.018, respectively), and standard-risk patients (P = 0.014 and 0.007, respectively). The overall mortality rate for induction therapy in the MRC UKALLXII/ECOG E2993 group was 2.1% (1 of 47 patients). One or more instances of grade IV myelosuppression occurred during induction therapy. Among the non-hematological toxicities, alopecia and elevated ALT and AST levels were the most common. The levels of ALT and AST could be reduced to less than twofold the normal values within 1-2 weeks. The data indicate that the MRC UKALLXII/ECOG E2993 regimen is well tolerated in Chinese adults with ALL and can improve survival compared with the JALSG ALL 87 protocol. Risk stratification at diagnosis based on age and WBC count is suitable for adults with ALL, and it is necessary to adopt different strategies as determined by diagnostic results. Lastly, Ph+ patients have an extremely poor prognosis.
对单家机构的新诊断为急性淋巴细胞白血病（ALL）的患者进行了回顾性分析。2006 年至 2010 年，47 例患者采用 MRC UKALLXII/ECOG E2993 方案治疗。在 2005 年 7 月之前，40 例患者采用 JALSG ALL 87 方案治疗。E2993 方案的完全缓解（CR）率为 91.5%，与 JALSG 方案的 80%相比没有显著提高（P>0.05）。采用 MRC UKALLXII/ECOG E2993 方案治疗的所有患者中，CR 持续时间的中位数为 19 个月。Ph+患者的 CR 持续时间中位数为 11.5 个月，而 Ph-患者的 CR 持续时间显著更长，为 19 个月（P=0.019）。此外，标准风险（基于诊断时的年龄和白细胞计数分层）的 Ph-患者的 CR 持续时间为 21 个月，明显长于高危组的 10 例 Ph-患者的 12 个月 CR 持续时间（P=0.001）。在以下三个队列中，MRC UKALLXII/ECOG E2993 和 JALSG ALL 87 组之间的 2 年无事件生存率和总生存率存在显著差异：所有患者（P=0.009 和 0.022），Ph-患者（P=0.009 和 0.018）和标准风险患者（P=0.014 和 0.007）。MRC UKALLXII/ECOG E2993 组诱导治疗的总死亡率为 2.1%（47 例患者中有 1 例）。在诱导治疗期间发生 1 例或更多例 4 级骨髓抑制。在非血液学毒性中，脱发和 ALT、AST 水平升高最为常见。ALT 和 AST 水平可在 1-2 周内降低至正常值的两倍以下。数据表明，MRC UKALLXII/ECOG E2993 方案在接受治疗的中国成年人 ALL 患者中具有良好的耐受性，与 JALSG ALL 87 方案相比可改善生存率。基于年龄和 WBC 计数的诊断时风险分层适用于 ALL 患者，需要根据诊断结果采用不同的策略。最后，Ph+患者的预后极差。
