Optimization And Exploration Of Remission Induction Program For Philadelphia Chromosome-positive Adult Acute Lymphoblastic Leukemia In The Era Of DRG Payment

Objective: The DRG charge reform aims to reduce health care costs while ensuring quality.This study discusses how to optimize the remission induction program of Philadelphia chromosome-positive adult acute lymphoblastic leukemia in the era of DRG payment.Methods: A retrospective analysis of 81 newly diagnosed Philadelphia chromosome-positive adult acute lymphoblastic leukemia from January 2017 to January2020.According to the selection of the first induction chemotherapy regimen,the patients were divided into the tyrosine kinase inhibitors(TKI)combined with reduced-intensity chemotherapy group(VP 、 VIP 、 VDP)(17 cases)and the TKI combined with conventional chemotherapy group(VICLP、VDCLP、VICP、VDCP、hyper-CVAD)(64 cases).To compare the hospital stay,fever days,myelosuppression recovery days after chemotherapy,adverse reactions,cost,early mortality,complete response(CR)rate,recurrence rate,disease-free survival(DFS),total survival(OS)and other indicators were compared between the two groups.The mean follow-up time was13.33 months(range 0-36 months).Results:1.For the first time the induction chemotherapy TKI combined reduced-intensity chemotherapy group contrast TKI combined conventional dose chemotherapy group,two groups in the early mortality(P>0.05),Complete response(CR)rate(P=0.865),recurrence rate(P=0.723),disease-free survival(DFS)(P=0.454),overall survival(OS)(P=0.191)no statistically significant differences,the results show that for the first time the induction chemotherapy TKI combination of reduced-intensity chemotherapy group in the near future curative effect and long-term efficacy and was equal to that of conventional dose chemotherapy group.2.For the first time the induction chemotherapy TKI combined reduced-intensity chemotherapy group contrast TKI combined routine chemotherapy group,the proportion of patients in two groups during hospital days≤21 days(47.1% vs 20.3%,P=0.034),fever days≧8 days(17.7% vs 45.3%,P=0.038),after chemotherapy bone marrow inhibit platelet recovery time ≤16 days(56.3% vs 22.6%,P=0.0.39),kinds of antibiotic use>4kinds(11.8% vs 42.2%,P=0.020),expenses for inspection ≤ 45000(yuan)(94.1% vs65.6%,P=0.031),expenses for medicine(P=0.031),total cost ≤90000(yuan)(100% vs76.6%,P=0.032)had statistically difference.Results show that the TKI combined reduced-intensity chemotherapy group in shorten the hospitalization days,fever days,the recovery time of myelosuppression after chemotherapy,infection times and total cost had obvious advantages over the conventional chemotherapy group.Conclusion: In the treatment of initial Philadelphia chromosome-positive adult acute lymphoblastic leukemia,TKI combined with reduced-intensity chemotherapy group contrast TKI combined routine chemotherapy group not worse than in complete remission and the long-term survival in patients,however,can reduce the time of bone marrow after chemotherapy in patients,reduce chemotherapy related adverse reaction,so as to shorten the hospitalization days of patients,reduce hospitalization costs,reduce the economic burden of patients,improve patient treatment compliance.The results of the study showed that TKI combined with low-intensity chemotherapy group was a feasible induced remission scheme for the initial treatment of adult patients with Ph+ALL.