| Background and objective:Acute lymphoblastic leukemia(ALL)is a common type of leukemia,most commonly occurring in children.Adults account for about 15～20% of all ALL.With the continuous progress of chemotherapy research,the remission rate of childhood ALL can reach 90%.According to literature reports,about 75% to 89% of adult ALL can achieve complete remission(CR).However,after remission,the recurrence rate of adult ALL is high,and the clinical mortality rate is high,so the treatment of adult relapsed ALL is extremely challenging.The purpose of this study is to explore the clinical characteristics and prognostic factors of adult patients with relapsed ALL,and to provide evidence for individualized treatment of adult relapsed ALL.Methods:The clinical data of 59 newly diagnosed adult relapsed ALL patients admitted to the Department of Hematology,The First Bethune Hospital of Jilin University from January 2019 to September 2022 were retrospectively analyzed.SPSS 25.0 was used for statistical analysis,and Graphpad Prism 9.0 was used for survival curve drawing.The measurement data was nonnormal distribution and described by median(range);Counting data was expressed by frequency(percentage).Kaplan-Meier method was used for univariate analysis of prognostic factors.Log-rank test was used to compare the survival curve.Cox regression model was used in multivariate survival analysis,P<0.05 was considered a statistically significant difference.Results:1.A total of 59 newly diagnosed adult patients with relapsed ALL were enrolled,including 27 males(45.8%)and 32 females(54.2%).The male to female ratio was 0.84:1,and the median age of onset was 34(18～72)years.There were 51 patients with relapsed B-ALL,accounting for 86.4%,and 8 patients with relapsed T-ALL,accounting for 13.6%.2.59 patients had complete cytogenetic data,of which 17 cases had normal chromosome karyotypes,accounting for 28.8%;There were 42 cases with abnormal chromosome karyotypes,accounting for 71.2%.Abnormal chromosome types mainly included the following three types: structural abnormalities,numerical abnormalities,and complex karyotypes.In all cases,Philadelphia chromosome(Ph)positive and/or BCR/ABL fusion gene positive cases were the most common,with a total of 21 cases,accounting for 35.6% of all cases.In addition to the BCR/ABL fusion gene,there were also 5 cases of KMT2 A fusion gene,3 cases of SIL-TAL1 fusion gene,2 cases of E2A-PBX1 fusion gene,and 1 case of BCRFGFR1 fusion gene.3.Of the total cases,47 patients(79.7%)were able to detect gene mutations,and 39 kinds of gene mutations were detected.The median number of mutations was 2(0～6).Of these,12patients(20.3%)were able to detect 3 or more gene mutations.There were 7 genes with mutation frequency above 5%,including N-RAS(8.47%),K-RAS(6.78%),PTEN,IKZF1,PAX5,TP53,and SH2B3.4.A total of 53 patients with ALL who received treatment after their first relapse,accounting for 89.8% of the total,included 45 patients with B-ALL(18 cases with Ph positive and 27 cases with Ph negative),and 8 patients with T-ALL.18 patients received allogeneic hematopoietic stem cell transplantation(allo-HSCT),including 12 patients who were bridged with allo-HSCT after chemotherapy;there were 3 patients with salvage allo-HSCT and 3patients with immunotherapy before allo-HSCT(2 patients were Bi TE and 1 patient was INO).29 patients received chemotherapy alone,including Hyper-CVAD(A/B)in 14 cases,[VP]based in 8 cases,simple lumbar puncture in 2 cases,VMMD in 3 cases and CAM in 2 cases.6 patients received immunotherapy,including 2 cases of CAR-T,2 cases of INO and 2 cases of Bi TE monotherapy.After receiving treatment,37 patients achieved CR,accounting for69.8%,while 9 patients did not achieve CR,accounting for 17.0%.By the end of follow-up,a total of 29 patients had died,with a total mortality rate of 49.1%,a total survival rate of 50.9%,and a median survival period of 35.73(20.62 to 50.84)months.5.Univariate and multivariate analysis of prognosis: Univariate analysis showed that age,ECOG score,TP53 mutation gene,KMT2 A fusion gene,allo-HSCT and treatment for the first relapse were the risk factors affecting OS in patients.Among the 53 patients with relapsed ALL who received treatment,remission of first relapse treatment,first relapse treatment combined with sepsis,chemotherapy combined with other treatments after relapse were risk factors affecting OS in patients.Multivariate analysis showed that age≥55 years old,positive TP53 mutation gene,KMT2 A fusion gene positive and allo-HSCT were independent risk factors affecting OS in patients.Conclusions:1.Adult patients with relapsed ALL had poor prognosis and poor overall efficacy.2.Immunotherapy and allo-HSCT can significantly improve the prognosis of adult relapsed ALL.3.Age≥55 years old,positive TP53 mutation gene,KMT2 A fusion gene positive and allo-HSCT were independent risk factors affecting OS in patients. |
PDF Full Text Request