Zhang Yi, Qian Jie-Jing, Zhou Yi-Le, Huang Xin, Li Jian-Hu, Li Xue-Ying, Li Chen-Ying, Wang Huan-Ping, Lou Yin-Jun, Meng Hai-Tao, Yu Wen-Juan, Tong Hong-Yan, Jin Jie, Zhu Hong-Hu
Department of Hematology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China.
Institute of Hematology, Zhejiang University, Hangzhou, China.
Front Oncol. 2020 Aug 21;10:1423. doi: 10.3389/fonc.2020.01423. eCollection 2020.
Adult T-cell acute lymphoblastic leukemia (T-ALL) is a rare hematological malignancy and significantly linked to poor outcomes. Early T-cell precursor (ETP) leukemia is a unique subtype of T-ALL. The aim of this study is to compare the differences between ETP and non-ETP ALLs in China. We retrospectively analyzed the records of 122 adult T-ALL patients diagnosed and treated at our center between January 2014 and June 2019. All the patients enrolled were categorized into ETP and non-ETP ALL by immunophenotype, and further statistical analyses about clinical data and prognostic factors were performed. Among the 122 cases, the male-to-female ratio was 2.8:1, and the median age is 29 (range, 16-82) years. Except for 10 patients with insufficient immunophenotyping results, 47.3% (53/112) are ETP and 52.7% (59/112) are non-ETP. Compared with non-ETP patients, ETP-ALL patients had lower white blood cell counts and lactate dehydrogenase levels, while they were older and had higher platelet counts and fibrinogen levels (all < 0.05). Complete remission (CR) was achieved in 68.0% (83/122) of patients, 64.2 and 76.3% in ETP and non-ETP, respectively ( = 0.160). In total, 44.6% (37/83) of patients relapsed. Allogeneic stem cell transplantation (allo-SCT) was successfully performed in 36.1% (44/122) of patients, of which 79.5% (35/44) were in CR1. With a median follow-up of 9.1 (range, 0.5-70.3) months, the estimated 2-year overall survival (OS) and relapse-free survival (RFS) rates for the cohort were 38.0 ± 5.1 and 39.1 ± 6.3%, respectively. In the ETP group, the 2-year OS rate was 40.7 ± 8.2% and the RFS rate was 47.2 ± 10.7%, while in the non-ETP group, the 2-year OS rate was 37.9 ± 7.0% and the RFS rate was 39.2 ± 8.3% (both > 0.05). In the landmark analysis of CR1 patients who had a survival of more than 6 months, the allo-SCT group had significantly better survival outcomes than the chemotherapy group, and the 2-year OS rates and RFS rates were 80.1 ± 7.3 vs. 28.4 ± 8.4% and 68.9 ± 8.8 vs. 12.8 ± 7.2%, respectively (both < 0.0001). A multivariate analysis suggests that allo-SCT acts as an independent prognostic factor for both OS and RFS. Our results revealed that ETP accounted for a high proportion of T-ALL in Chinese. There are no CR rates and prognosis differences between ETP and non-ETP. Allo-SCT in CR1 can significantly improve patients' survival.
成人T细胞急性淋巴细胞白血病（T-ALL）是一种罕见的血液系统恶性肿瘤，与不良预后显著相关。早期T细胞前体（ETP）白血病是T-ALL的一种独特亚型。本研究旨在比较中国ETP-ALL和非ETP-ALL之间的差异。我们回顾性分析了2014年1月至2019年6月在本中心诊断和治疗的122例成人T-ALL患者的记录。所有纳入患者根据免疫表型分为ETP-ALL和非ETP-ALL，并对临床数据和预后因素进行进一步统计分析。122例患者中，男女比例为2.8∶1，中位年龄为29岁（范围16～82岁）。除10例免疫表型结果不足的患者外，47.3%（53/112）为ETP-ALL，52.7%（59/112）为非ETP-ALL。与非ETP患者相比，ETP-ALL患者白细胞计数和乳酸脱氢酶水平较低，年龄较大，血小板计数和纤维蛋白原水平较高（均P＜0.05）。68.0%（83/122）的患者达到完全缓解（CR），ETP-ALL和非ETP-ALL分别为64.2%和76.3%（P = 0.160）。共有44.6%（37/83）的患者复发。36.1%（44/122）的患者成功进行了异基因造血干细胞移植（allo-SCT），其中79.5%（35/44）处于CR1期。中位随访9.1个月（范围0.5～70.3个月），该队列的估计2年总生存率（OS）和无复发生存率（RFS）分别为38.0±5.1%和39.1±6.3%。在ETP组中，2年OS率为40.7±8.2%，RFS率为47.2±10.7%；在非ETP组中，2年OS率为37.9±7.0%，RFS率为39.2±8.3%（均P＞0.05）。在生存超过6个月的CR1患者的标志性分析中，allo-SCT组的生存结果明显优于化疗组，2年OS率和RFS率分别为80.1±7.3%对28.4±8.4%和68.9±8.8%对12.8±7.2%（均P＜0.0001）。多因素分析表明，allo-SCT是OS和RFS的独立预后因素。我们的结果显示，在中国，ETP在T-ALL中占很高比例。ETP和非ETP之间的CR率和预后无差异。CR1期进行allo-SCT可显著改善患者生存。
