Shaare Zedek Medical Center, Jerusalem, Israel.
Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel.
Br J Haematol. 2020 Oct;191(1):37-43. doi: 10.1111/bjh.16616. Epub 2020 Mar 27.
Late relapse [>3 years from complete remission (CR)] in acute lymphoblastic leukaemia (ALL), is unusual. Data from the MRC UKALLXII/ECOG E2993 trial are presented to evaluate the incidence and characteristics of late relapse in adult ALL. Of 1,909 patients, 1,752 (92%) achieved CR and among these 757 (43·2%) relapsed; 691 (91·3%) within three years and 66 (8·7%) beyond. Among these 66 patients, median time to relapse was 47 (37-144) months. Relapse beyond three years occurred in 3·8% of all who achieved CR. The cumulative risk of relapse was 40%, 43% and 45% at three, five and ten years respectively. Out of the 1 752 patients who achieved CR, 11·7% underwent autologous and 40·6% allogeneic transplant, while in CR1. Of the autologous patients, 43·2% relapsed early and 3·4% relapsed late. However, among the allogeneic patients, 13·2% relapsed early and only 1·3% late. The five-year overall survival from relapse was 5·8% and 20% in the early and late relapse patients respectively. In conclusion, late relapse in adults with ALL is not uncommon, and is associated with better outcome after relapse compared to early relapse.
急性淋巴细胞白血病（ALL）完全缓解（CR）后 3 年以上的迟发性复发较为少见。本文报告了 MRC UKALLXII/ECOG E2993 试验的数据，以评估成人 ALL 迟发性复发的发生率和特征。在 1909 例患者中，1752 例（92%）达到 CR，其中 757 例（43·2%）复发；691 例（91·3%）在三年内，66 例（8·7%）超过三年。在这 66 例患者中，中位复发时间为 47（37-144）个月。所有达到 CR 的患者中，超过 3 年的迟发性复发率为 3.8%。复发的累积风险分别为 3、5 和 10 年时的 40%、43%和 45%。在 1752 例达到 CR 的患者中，11.7%接受了自体移植，40.6%接受了异基因移植，而在 CR1 中则分别为 43.2%和 3.4%。在自体移植患者中，43.2%的患者早期复发，3.4%的患者晚期复发。然而，在异基因移植患者中，13.2%的患者早期复发，只有 1.3%的患者晚期复发。迟发性复发患者的 5 年总生存率为 5.8%，而早期复发患者为 20%。总之，ALL 成人患者的迟发性复发并不少见，与早期复发相比，迟发性复发后缓解的结局更好。
