Lee Jung Min, Kim Do Young, Cho Hee Jeong, Moon Joon Ho, Sohn Sang Kyun, Shin Ho Jin, Do Young Rok, Heo Mi Hwa, Kim Min Kyoung, Park Young Seob, Baek Dong Won
Department of Hematology/Oncology, Kyungpook National University Hospital, School of Medicine, Kyungpook National University, Daegu, Korea.
Division of Hematology-Oncology, Department of Internal Medicine, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Korea.
Korean J Intern Med. 2025 Jan;40(1):124-134. doi: 10.3904/kjim.2024.227. Epub 2025 Jan 1.
BACKGROUND/AIMS: To determine the effectiveness of tyrosine kinase inhibitor (TKI) plus reduced-intensity therapy in adult patients with newly diagnosed Philadelphia chromosome-positive acute lymphoblastic leukemia (Ph-positive ALL), this retrospective study compared treatment outcomes and induction mortality according to backbone regimen intensity.
The data of 132 patients diagnosed with Ph-positive ALL were retrospectively collected from five centers. Patients received imatinib plus intensive chemotherapy (modified VPD, KALLA1407, or hyper-CVAD) or reduced-intensity chemotherapy (EWALL) for curative purposes. This study analyzed 117 patients, of which 35,22,46, and 14 received modified VPD, KALLA1407, hyper-CVAD, and EWALL, respectively. All patients used imatinib as a TKI.
The median age of the patients who received reduced-intensity chemotherapy was 64.4 years, while that of the patients with intensive regimens was 47.5 years. There was no induction death in the reduced-intensity group, while nine patients died in the intensive therapy group. Major molecular response achievement tended to be higher in the intensive chemotherapy group than in the reduced-intensity group. More patients in the intensive chemotherapy group received allogeneic stem cell transplantation (allo-SCT). There was no statistically significant difference in long-term survival between the two groups in terms of relapse-free survival and overall survival rates.
When imatinib plus reduced-intensity therapy was used as a frontline treatment, there was no inferiority in obtaining complete remission compared to imatinib plus intensive chemotherapy or significant difference in long-term survival. Since imatinib plus reduced-intensity therapy has limitations in obtaining a deep molecular response, proceeding to allo-SCT should be considered.
背景/目的：为确定酪氨酸激酶抑制剂（TKI）联合降低强度治疗方案对新诊断的费城染色体阳性急性淋巴细胞白血病（Ph 阳性 ALL）成年患者的疗效，本回顾性研究根据基础方案强度比较了治疗结果和诱导死亡率。
回顾性收集了来自五个中心的 132 例诊断为 Ph 阳性 ALL 的患者的数据。患者接受伊马替尼联合强化化疗（改良 VPD、KALLA1407 或 hyper-CVAD）或降低强度化疗（EWALL）以达到治愈目的。本研究分析了 117 例患者，其中 35 例、22 例、46 例和 14 例分别接受了改良 VPD、KALLA1407、hyper-CVAD 和 EWALL 方案治疗。所有患者均使用伊马替尼作为 TKI。
接受降低强度化疗的患者中位年龄为 64.4 岁，而接受强化方案的患者中位年龄为 47.5 岁。降低强度组无诱导死亡，而强化治疗组有 9 例患者死亡。强化化疗组主要分子反应的达成率倾向于高于降低强度组。强化化疗组更多患者接受了异基因干细胞移植（allo-SCT）。两组在无复发生存率和总生存率方面的长期生存无统计学显著差异。
当伊马替尼联合降低强度治疗作为一线治疗时，与伊马替尼联合强化化疗相比，在获得完全缓解方面并无劣势，且长期生存无显著差异。由于伊马替尼联合降低强度治疗在获得深度分子反应方面存在局限性，应考虑进行 allo-SCT。
