Fujian Institute of Hematology, Fujian Medical University Union Hospital, Fuzhou, China.
Fujian Provincial Key Laboratory on Hematology, Fujian Medical University Union Hospital, Fuzhou, China.
Ann Hematol. 2023 Jul;102(7):1825-1835. doi: 10.1007/s00277-023-05267-6. Epub 2023 May 13.
The cure rate of acute lymphoblastic leukemia (ALL) in adolescents and adults remains poor. This study aimed to establish a prognostic model for ≥14-year-old patients with ALL to guide treatment decisions. We retrospectively analyzed the data of 321 ALL patients between January 2017 and June 2020. Patients were randomly (2:1 ratio) divided into either the training or validation set. A nomogram was used to construct a prognostic model. Multivariate Cox analysis of the training set showed that age > 50 years, white blood cell count > 28.52×10/L, and MLL rearrangement were independent risk factors for overall survival (OS), while platelet count >37×10/L was an independent protective factor. The nomogram was established according to these independent prognostic factors in the training set, where patients were grouped into two categories: low-risk (≤13.15) and high-risk (>13.15). The survival analysis, for either total patients or sub-group patients, showed that both OS and progression-free survival (PFS) of low-risk patients was significantly better than that of high-risk patients. Moreover, treatment analysis showed that both OS and progression-free survival (PFS) of ALL with stem cell transplantation (SCT) were significantly better than that of ALL without SCT. Further stratified analysis showed that in low-risk patients, the OS and PFS of patients with SCT were significantly better than those of patients without SCT. In contrast, in high-risk patients, compared with non-SCT patients, receiving SCT can only significantly prolong the PFS, but it does not benefit the OS. We established a simple and effective prognostic model for ≥ 14-year-old patients with ALL that can provide accurate risk stratification and determine the clinical strategy.
急性淋巴细胞白血病（ALL）在青少年和成人中的治愈率仍然较差。本研究旨在为≥14 岁的 ALL 患者建立一个预后模型，以指导治疗决策。我们回顾性分析了 2017 年 1 月至 2020 年 6 月间 321 例 ALL 患者的数据。患者被随机（2:1 比例）分为训练集或验证集。使用列线图构建预后模型。训练集中的多变量 Cox 分析显示，年龄＞50 岁、白细胞计数＞28.52×10/L 和 MLL 重排是总生存（OS）的独立危险因素，而血小板计数＞37×10/L 是独立的保护因素。根据该训练集中的这些独立预后因素建立了列线图，其中患者被分为低危（≤13.15）和高危（＞13.15）两类。生存分析，无论是对所有患者还是亚组患者，均显示低危患者的 OS 和无进展生存（PFS）均明显优于高危患者。此外，治疗分析显示，ALL 患者接受干细胞移植（SCT）的 OS 和 PFS 均明显优于未接受 SCT 的 ALL 患者。进一步分层分析显示，在低危患者中，接受 SCT 的患者的 OS 和 PFS 明显优于未接受 SCT 的患者。相反，在高危患者中，与非 SCT 患者相比，接受 SCT 仅能显著延长 PFS，但不能改善 OS。我们为≥14 岁的 ALL 患者建立了一个简单有效的预后模型，可提供准确的风险分层并确定临床策略。
