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采用儿科方案类型治疗的初发性急性淋巴细胞白血病青少年和青年的长期预后

[Long-term destiny of adolescents and young adults with de novo acute lymphoblastic leukemia treated with a pediatric protocol type].

作者信息

López-Hernández Manuel Antonio, Alvarado-Ibarra Martha, Álvarez-Veral José Luis, Ortiz-Zepeda Maricela, Guajardo-Leal Martha Lilia, Cota-Range Xochitl

机构信息

Servicio de Hematología, Centro Médico Nacional 20 de Noviembre, ISSSTE, Ciudad de México, México.

出版信息

Gac Med Mex. 2016 Sep-Oct;152(5):439-443.

Abstract

INTRODUCTION

The prognosis, in the long term, of adolescents and young adults with acute de novo lymphoblastic leukemia, treated with a pediatric type protocol.

OBJECTIVE

To analyze the efficacy and tolerability of a chemotherapy regimen of pediatric type on patients 15-35 years old with de novo acute lymphoblastic leukemia, Ph(-).

METHODS

A retrospective study of patients received from 2001 to 2013, without initial infiltration of the central nervous system. They received the regimen called LALÍN. Terminal goals: frequency of initial remission, probability of survival free of leukemia and event-free survival for five years.

RESULTS

We included 101 patients; there were 29 relapses and 19 deaths. There was initial remission in 97% of the cases; survival free of leukemia of 0.58 and event-free survival 0.44. No difference in patients aged 16-21 years vs. 22-35 (p > 0.55). Negative prognostic factors: abnormal karyotypes, except hyperdiploids (p = 0.001); > 5% of blasts, on 14 day induction (p = 0. 0001); delay in the punctuality of the courses of the chemotherapy regimen (p = 0.0001).

CONCLUSION

A pediatric type regimen is applicable to patients aged from 16 to 35 years with acute lymphoblastic leukemia, without greater toxicity and a best survival free of leukemia. The count of > 5% of blasts and the delay in the execution of the stages of the chemotherapy regimen are the stronger negative prognostic factors.

摘要

引言

采用儿科方案治疗的青少年及青年急性原发性淋巴细胞白血病的长期预后。

目的

分析儿科化疗方案对15 - 35岁原发性急性淋巴细胞白血病(Ph(-))患者的疗效及耐受性。

方法

对2001年至2013年收治的无中枢神经系统初始浸润的患者进行回顾性研究。他们接受名为LALÍN的方案。最终目标:初始缓解频率、无白血病生存率及五年无事件生存率。

结果

纳入101例患者;29例复发,19例死亡。97%的病例实现初始缓解;无白血病生存率为0.58,无事件生存率为0.44。16 - 21岁患者与22 - 35岁患者之间无差异(p > 0.55)。不良预后因素:除超二倍体外的异常核型(p = 0.001);诱导第14天原始细胞> 5%(p = 0.0001);化疗方案疗程准时性延迟(p = 0.0001)。

结论

儿科方案适用于16至35岁的急性淋巴细胞白血病患者,毒性不大且无白血病生存率更佳。原始细胞计数> 5%及化疗方案阶段执行延迟是更强的不良预后因素。

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