| Objective To compare the clinical efficacy of initially treated Philadelphia chromosome positive(Ph+)chemotherapy combined with Tyrosine kinase inh-ibitors(TKI)with routine chemotherapy for Philadelphia chromosome negati-ve(Ph-)acute lymphoblastic leukemia(ALL)and to investigate the hospitai-zation costs.Methods Collected in our hospital between January 2017 and February 2020 who were diagnosed in adults treated first,a total of 221 cases of patients with ALL,whether by the philadelphia chromosome positive divided into phi-ladelphia chromosome negative(Ph-ALL)group(140 cases)and philadephia chromosome positive(Ph+ALL)group(81 cases).Analysis the remission rate,relapse rate,disease-free survival time diseases-free survival(DFS)and Ove-rall survival time(Overall survival,OS),the time of bone marrow suppressi-on after chemotherapy,and infection index,to evaluate the clinical efficacy of Ph+ALL in TKI combined chemotherapy and Ph-ALL treated with chemo-therapy,and analyze the initial hospitalization cost and cost composition of patients in the Ph+ALL group and the Ph-ALL group.Results Up to February 1,2020,140 patients in the Ph-ALL group were followed up,of which 80 survived,55 died and 5 lost to follow-up.There were 81 cases in the Ph+ALL group,among which 34 survived,46 died and 1 lost to follow-up.Median OS 24(1-37)months in the Ph-ALL group and median OS 16(1-37)months in the Ph+ALL group,univariate and COX regression analysis showed that transplantation was an independent fact or affecting survival time(P=0.000).OS in the Ph-ALL group was significantly longer than that in the Ph+ALL group,and the difference between the two groups was statistically significant(P<0.05).The median DFS in the PhALL group was 12.5(0-37)months,and the median DFS in the Ph+ALL gr-oup was 9.3(0-36)months.There was a statistically significant difference in DFS between the two groups(P<0.05).About 93.83% of patients with Ph+ALL spent less than 110,000 on the first hospitalization,and 83.45% of pa-tients in the Ph-ALL group spent less than 110,000 on their first hospitaliza-tion,with statistically significant differences(P<0.05).The drug cost and exa-mination cost in the Ph+ALL group were lower than that in the Ph-ALL gr-oup,and the blood transfusion cost was higher than that in the Ph-ALL gro-up,with statistically significant differences(P<0.05).When the expenses of antibacterial agents in the Ph-ALL group and the Ph+ALL group were10,000 yuan and 20,000 yuan,the difference between the two groups was statistically significant(P<0.01).When the expenses of antifungal agent in the two groups were 10,000 yuan and 35,000 yuan,the difference was statis-tically significant(P<0.05).Conclusions(1)The remission rate,recurrence rate and prognosis of Ph+A LL patients were significantly improved under chemotherapy combined with TKI.And TKI does not increase the treatment related side effects.But compar-ed with patients with Ph-ALL,OS and DFS were still worse.Philadephia ch-romosome positivity was still a high risk factor for ALL with poor prognos-is. (2)The high cost of initial treatment of ALL is mainly reflected in the cost of medicine and blood transfusion,and anti-infective drugs are the main component of the cost of drugs.Fever days(infection)is the main factor affe-cting the hospitalization expenses.We should pay attention to the rational use of antibiotics by inpatients,so as to reduce the hospitalization expenses and reduce the burden on patients and medical insurance. (3)The difference in the first hospitalization cost between patients with PhALL and patients with Ph+ALL was statistically significant.In the context of the implementation of diagnosis-related groups(DRGs)charging and pay-ment,it is suggested to divide ALL into Ph-ALL and Ph+ALL DRG groups to settle payment,which will be more objective.This study provides theore-tical reference for the improvement of DRGs charging standard for acute ly-mphoblastic leukemia. |
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