Gökbuget Nicola, Dombret Hervè, Ribera Jose-Maria, Fielding Adele K, Advani Anjali, Bassan Renato, Chia Victoria, Doubek Michael, Giebel Sebastian, Hoelzer Dieter, Ifrah Norbert, Katz Aaron, Kelsh Michael, Martinelli Giovanni, Morgades Mireia, O'Brien Susan, Rowe Jacob M, Stieglmaier Julia, Wadleigh Martha, Kantarjian Hagop
University Hospital, Goethe University, Frankfurt, Germany
Hôpital Saint-Louis, Paris, France.
Haematologica. 2016 Dec;101(12):1524-1533. doi: 10.3324/haematol.2016.144311. Epub 2016 Sep 1.
Adults with relapsed/refractory acute lymphoblastic leukemia have an unfavourable prognosis, which is influenced by disease and patient characteristics. To further evaluate these characteristics, a retrospective analysis of 1,706 adult patients with Ph-negative relapsed/refractory B-precursor acute lymphoblastic leukemia diagnosed between 1990-2013 was conducted using data reflecting the standard of care from 11 study groups and large centers in Europe and the United States. Outcomes included complete remission, overall survival, and realization of stem cell transplantation after salvage treatment. The overall complete remission rate after first salvage was 40%, ranging from 35%-41% across disease status categories (primary refractory, relapsed with or without prior transplant), and was lower after second (21%) and third or greater (11%) salvage. The overall complete remission rate was higher for patients diagnosed from 2005 onward (45%, 95% CI: 39%-50%). One- and three-year survival rates after first, second, and third or greater salvage were 26% and 11%, 18% and 6%, and 15% and 4%, respectively, and rates were 2%-5% higher among patients diagnosed from 2005. Prognostic factors included younger age, longer duration of first remission, and lower white blood cell counts at primary diagnosis. This large dataset can provide detailed reference outcomes for patients with relapsed/refractory Ph-negative B-precursor acute lymphoblastic leukemia. clinicaltrials.gov identifier: 02003612.
复发/难治性急性淋巴细胞白血病的成年患者预后不佳，这受到疾病和患者特征的影响。为了进一步评估这些特征，利用来自欧洲和美国11个研究组和大型中心反映标准治疗的数据，对1990年至2013年间诊断的1706例Ph阴性复发/难治性B前体急性淋巴细胞白血病成年患者进行了回顾性分析。结果包括完全缓解、总生存期以及挽救治疗后干细胞移植的实现情况。首次挽救后的总体完全缓解率为40%，在不同疾病状态类别（原发难治、有或无既往移植的复发）中为35% - 41%，第二次挽救后（21%）和第三次或更多次挽救后（11%）更低。2005年以后诊断的患者总体完全缓解率更高（45%，95%置信区间：39% - 50%）。首次、第二次和第三次或更多次挽救后的1年和3年生存率分别为26%和11%、18%和6%、15%和4%，2005年诊断的患者生存率高2% - 5%。预后因素包括年龄较小、首次缓解持续时间较长以及初诊时白细胞计数较低。这个大型数据集可为复发/难治性Ph阴性B前体急性淋巴细胞白血病患者提供详细的参考结果。临床试验.gov标识符：02003612。
