Jaime-Pérez José Carlos, Jiménez-Castillo Raúl Alberto, Herrera-Garza José Luis, Gutiérrez-Aguirre Homero, Marfil-Rivera Luis Javier, Gómez-Almaguer David
Department of Hematology, "Dr. José Eleuterio González" University Hospital, School of Medicine, Universidad Autónoma de Nuevo León, Monterrey, Mexico.
Department of Hematology, "Dr. José Eleuterio González" University Hospital, School of Medicine, Universidad Autónoma de Nuevo León, Monterrey, Mexico.
Clin Lymphoma Myeloma Leuk. 2017 Jan;17(1):60-68. doi: 10.1016/j.clml.2016.08.013. Epub 2016 Aug 10.
The therapeutic progress for adults with acute lymphoblastic leukemia (ALL) has been slow, with a 5-year survival of 30% to 45% in developed countries. Scarce information is available regarding the treatment and survival rates from nonindustrialized populations. In the present study, the characteristics of adults with ALL at a single institution were documented.
The clinical files of patients aged ≥ 18 years who had been diagnosed with ALL from 2005 to 2015 at a reference center in Mexico were scrutinized. Overall survival (OS) and event-free survival (EFS) were determined using the Kaplan-Meier method. The hazard ratios for death and relapse were estimated using Cox regression analysis.
A total of 94 adults were included. Their median age was 33 years; 69 (73.4%) had high-risk and 25 (26.6%) had standard-risk ALL. Of the 94 patients, 67 (71.3%) achieved complete remission (CR), 20 (21.3%) experienced disease resistance, and 7 (7.4%) died early during induction to remission, mainly of sepsis. The 5-year EFS and OS was 23.4% and 31.1% for the whole group and 24.9% and 38.9% for patients who achieved CR, respectively. Of the 94 patients, 50 (43.9%) died of sepsis or disease progression. Relapse developed in 43 patients (45.7%). The median survival after relapse was 6.93 months. Bone marrow was the most frequent site of relapse (21 patients [48.8%]) and conferred a significantly lower 5-year OS of 16.4%.
Adults with ALL in Mexico had high-risk characteristics and an increased relapse rate; however, the OS after CR was similar to the greatest achieved in developed countries, suggesting that a threshold for curing adult ALL with current therapeutic strategies has been reached.
成人急性淋巴细胞白血病（ALL）的治疗进展缓慢，在发达国家5年生存率为30%至45%。关于非工业化人群的治疗和生存率的信息稀缺。在本研究中，记录了一家机构中成人ALL患者的特征。
仔细查阅了2005年至2015年在墨西哥一家参考中心诊断为ALL的年龄≥18岁患者的临床档案。采用Kaplan-Meier方法确定总生存期（OS）和无事件生存期（EFS）。使用Cox回归分析估计死亡和复发的风险比。
共纳入94例成人患者。他们的中位年龄为33岁；69例（73.4%）为高危ALL，25例（26.6%）为标危ALL。94例患者中，67例（71.3%）实现完全缓解（CR），20例（21.3%）出现疾病抵抗，7例（7.4%）在诱导缓解早期死亡，主要死于败血症。整个组的5年EFS和OS分别为23.4%和31.1%，实现CR的患者分别为24.9%和38.9%。94例患者中，50例（43.9%）死于败血症或疾病进展。43例患者（45.7%）出现复发。复发后的中位生存期为6.93个月。骨髓是最常见的复发部位（21例患者[48.8%]），5年OS显著较低，为16.4%。
墨西哥的成人ALL患者具有高危特征且复发率增加；然而，CR后的OS与发达国家所达到的最佳结果相似，这表明当前治疗策略治愈成人ALL已达到一个阈值。
