| Objective:To study the treatment results and prognostic factors of acute lymphoblastic leukemia (ALL) patients with ALL-BFM95.Methods:Data of 63 ALL patients hospitalized in our institute from January 2010 to May 2015 were retrospectively reviewed. There were 31 patients younger than 14 years,32 patients aged 14 years old or above. After one course of induction chemotherapy,60 patients can be valuated on the treatment reaction. A total of 52 patients got complete remission (CR),8 patients failed to get CR. In the pediatric patients, there were 16 patients of B-cell ALL,13 patients of T-cell ALL,1 patient of biphenotype and 1 patients of undefined phenotype. In the adult patients, there were 21 patients of B-cell ALL,8 patients of T-cell ALL and 1 patients of undefined phenotype. A total of 42 patients detected the fusion gene, BCR/ABL or MLL/AF4 positive was found in 7 patients, BCR/ABL and MLL/AF4 negative were found in 35 patients. According to the initial leukocyte counts, patients were divided into two groups: <50×109/L group of 49 patients,≥50×109/L group of 14 patients. According to the response to prednisone, patients were divided into two groups:good response to prednisone (PGR) of 17 cases and poor response to prednisone (PPR) of 22 cases. The last follow-up time was October 31th,2015.The median follow-up time was 15.3 months. Analyses for EFS and OS were performed according to the kaplan-Meier method, and survival curves were compared with the log-rank test. The multivariate analysis was performed using Cox’s proportional hazards regression model. And P<0.05 was considered to be statistically significant.Results:(1) The practical median EFS and OS of the 63 patients were 10.3 months and15.3 months,respectively. The prospective median EFS and OS were 20.2 months and 32.0 months,respectively. For the 63 ALL patients, the rate of 3-year EFS and 5-year EFS were 57.6% and 30.0%,respectively. The rate of 3-year OS and 5-year OS were 70.1% and 47.2%, respectively. (2) According to the age, patients were divided into childhood and adult group. The rate of 3-year EFS of them were 44.4% and 21.2%,respectively (P=0.018). The rate of 3-year OS of them were 64.3% and 30.8%, respectively (P-0.002). (3) According to the treatment reaction after one course of induction treatment, patients were divided into CR group and NR group. The rate of 3-year EFS of them were 59.1% and 0.0%(P=0.047). The rate of 3-year OS of them were 64.8% and 20.8%, respectively (P=0.037). (4) In the pediatric patients, the rate of 3-year EFS of B-cell and T-cell ALL group were 54.1% and 28.7%(P=0.077); the rate of 3-year OS of them were 69.2% and 32.6%, respectively (P=0.028). In the adult patients, the rate of 3-year EFS of B-cell and T-cell ALL group were 25.4% and 43.2%(P=0.163); the rate of 3-year OS of them were 25.5% and 71.1%, respectively (P=0.078). (5) According to the fusion gene examination, patients were divided into BCR/ABL and MLL/AF4 negative group and BCR/ABL or MLL/AF4positive group. The rate of 3-year EFS of them were 51.2% and 0.0%(P=0.060). The rate of 3-year OS of them were 57.0% and 34.3%, respectively (P=0.287). (6) According to the initial leukocyte counts, patients were divided into two groups:<50×109/L group and>50×109/L group. The rate of 3-year EFS of them were 50.7% and 16.7%(P=0.328). The rate of 3-year OS of them were 58.5% and 32.1%, respectively (P=0.062). (7) According to the response to prednisone, patients were divided into PGR group and PPR group. The rate of 3-year EFS of them were 44.1% and 25.3%(P=0.895).The rate of 3-year OS of them were 60.5% and 41.4%, respectively (P=0.827). (8) Cox regression analysis showed that the risk ratio (RR) of age (≥14 years), immuno-phenotype (T-ALL), the treatment reaction after induction treatment (NR) were all> 1.0. Among them, the age was independent prognostic factor of OS (P<0.019).Conclusion:(1) The median EFS and OS of the 63 patients were 20.2 months and 32.0 months,respectively. For the 63 ALL patients, the rate of 3-year EFS and 3-year OS were 57.6% and 70.1%,respectively.The rate of 5-year EFS and 5-year OS were 30.0% and 47.2%, respectively.(2) The univariate analysis showed that age and achieving CR or not after induction treatment were the prognostic factors on EFS and OS in patients with ALL.(3) The univariate analysis showed that immuno-phenotype was the prognostic factors on OS in pediatric patients with ALL.(4) The multivariate analysis showed that age was the independent prognostic factor on OS in patients with ALL. |
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