Vaezi Mohammad, Pourkhani Amirhoushang, Kasaeian Amir, Souri Maryam, Yaghmaie Marjan, Chardouli Bahram, Alimoghaddam Kamran, Ghavamzadeh Ardeshir
Reserach Institute for Oncology, Hematology and Cell Therapy, Tehran University of Medical Sciences, Tehran, Iran.
Department of Hematology/Oncology, Golestan University of Medical Sciences, Gorgan, Iran.
Int J Hematol Oncol Stem Cell Res. 2022 Jan 1;16(1):22-33. doi: 10.18502/ijhoscr.v16i1.8439.
Current treatment options of acute lymphoblastic leukemia(ALL) include chemotherapy alone or hematopoietic stem cell transplantation (HSCT) following induction chemotherapy both along with CNS prophylaxis. The usual and standard induction regimens currently administered could have severe complications and mortality. To lessen induction regimen complications in ALL patients who undergo HSCT, we used a cytoreduction induction regimen including dexamethasone (8 mg, IV, three times a day, for 28 days) and vincristine(1.4 mg/m, IV, on days 1,8,15 and 22) for 49 newly diagnosed adult ALL patients followed by an early sibling donor HSCT within two months. The results were matched with outcomes of HSCT in 172 ALL patients inducted by standard induction regimen. Median follow-up time was 5.41 years in the standard group and 5.27 years in the other. All patients of the case group (100%) achieved complete remission. Landmark analyses were performed to scrutinize the effect of treatments on different time intervals: first two years and 2 to end years. Type of treatment had no significant effect on the hazard of death in the first landmark (HR=0.87, P=0.64). Cytoreduction regimen amplified the hazard of death 3.43 times more than the standard regimen in the second landmark (HR=3.43 P=0.035). Multivariate analysis showed that the cytoreduction regimen reduced the hazard of relapse about 22%, but not statistically significant (HR=0.78, P-value=0.24). Overall, it seems despite achieving complete remission in induction therapy, depth of response is a critical predictor for long-term outcomes of HSCT in ALL patients, and the use of multiple agents may be necessary to decrease tumor cell burden and minimal residual disease(MRD).
急性淋巴细胞白血病（ALL）目前的治疗选择包括单纯化疗或诱导化疗后进行造血干细胞移植（HSCT），两者均需进行中枢神经系统预防。目前常用的标准诱导方案可能会有严重的并发症和死亡率。为了减少接受HSCT的ALL患者诱导方案的并发症，我们对49例新诊断的成年ALL患者采用了一种细胞减灭诱导方案，包括地塞米松（8毫克，静脉注射，每日3次，共28天）和长春新碱（1.4毫克/平方米，静脉注射，在第1、8、15和22天），随后在两个月内进行早期同胞供体HSCT。结果与172例采用标准诱导方案诱导的ALL患者的HSCT结果进行了匹配。标准组的中位随访时间为5.41年，另一组为5.27年。病例组的所有患者（100%）均实现完全缓解。进行了标志性分析以审查治疗在不同时间间隔的效果：前两年和2年至随访结束。治疗类型在第一个标志性时间点对死亡风险没有显著影响（风险比=0.87，P=0.64）。在第二个标志性时间点，细胞减灭方案使死亡风险比标准方案增加了3.43倍（风险比=3.43，P=0.035）。多变量分析表明，细胞减灭方案使复发风险降低了约22%，但无统计学意义（风险比=0.78，P值=0.24）。总体而言，尽管诱导治疗实现了完全缓解，但反应深度是ALL患者HSCT长期预后的关键预测因素，可能需要使用多种药物来降低肿瘤细胞负荷和微小残留病（MRD）。
