The Clinical Study About Acute Leukemia With Ph Chromosome Positive

Objectives: To clarify the clinical and biological characteristics, therapeutic outcome and prognosis of patients with Ph positive acute leukemia, exploring the optimal therapy for this disease.Methods: Retrospectively analyzing the clinical and biological characteristics, therapeutic outcome of 53 patients with Ph+ acute leukemia (AL) who are hospitalized in our hospital from year 2002 -2008. They are all diagnosed according to MIC(M) criteria. After got into complete remission with induction therapy, VDCP±L-ASP±Imatinib regimen, patients are given consolidation chemotherapy sequencely such as CAMML, HD-MTX, MA(MTZ+Arac). The characteristics of clinical, cytogenetics, treatment response, survival were analyzed, and the suitable therapy for Ph+ALL was discussed. All statistics were performed using the SPSS 13.0 soft ware.Results: Among the whole 53 patients, there are 33 males and 20 females. The median age is 33(14-58) years and median WBC count is 33. 5(1. 1-681)×10~9/L. 19 and 33 patients are diagnosed as hybrid acute leukemia and acute lymphoblastic leukemia respectively. All patients express CD10 with one excluded who was diagnosed as hybrid acute leukemia. Cytogenetic results were available for 45 patients. 12(26.7%) showed only t(9;22), 18(40%) showed normal karyotype, variant translocations or other chromosome aberrations, 15(33.3%) showed additional chromosome aberrations. BCR/ABL transcripts were detected in 12 (P210) and 30 (P190) patents respectively, and 6 patients have both detected. Patients with P210 expression are older than ones with P190.32 out of 37 patients who have received systemic treatment got into CR (CR rate is 86. 5%). All patients induced with imatinib and chemotherapy achieved CR, while 13 of 16 ones induced with chemotherapy alone come to CR. Within patients treated with imatinib at induction stage, 10/17(58.8%) patients became BCR/ABL negative. The median relapse free survival (RFS) is 19.8 months, with 1 year and 2 year RFS 58% and 29%. Median OS is 28 months with 1 year and 2 year OS 67%, 43% respectively. 10 patients received SCT, the median time from CR to transplantation is 135(59-305) days. Median RFS after transplantation 10.5(2-26) months. The median OS of patients receiving imatinib and chemotherapy or chemotherapy alone in the induction stage are 28 months and 21. 9 months (P>0. 05), while RFS are 29 months and 6.5 months (P<0.05) respectively.Conclusions: Ph+ALL are more common in acute lymphoblastic leukemia (with hyperleukocytosis at presentation), and can be seen in the hybrid acute leukemia too. The incidence of the disease is higher in male than female, and P190 expression is more often than P210. The CR rate can be improved with the introduction of imatinib. The optimal therapy for Ph+ALL is receiving allogenetic SCT after achieving CR with the imatinib and chemotherapy.