| Objective：To explore the clinical and biological features of acute lymphocytic leukemia(ALL) and assess the prognosis.Methods:In a restrospective follow-up study from2006.1~2010.12,222ALL patientswere investigated including115adult and107children. Blood routine test, lactatedehydrogenase (LDH), bone marrow morphology, bone marrow chromosome,immunophenotype and fusion genes were examined on all patients with ALL.According to the Morphology-Immunology-Cytogenetics-Molecular classification(MICM) of acute leukemia, ALL patients were divided into three groups, whoseclinical and biological features were analysed. The relationship between thesefeatures and the prognosis were assessed. Also, the clinical outcome and prognosisbetween children ALL and adult ALL were compared.Results:1.The overall survival (OS) and disease-free survival (DFS) in adult ALL (n=87)were lower than those in children ALL (n=85), i.e.18m vs36m,14m vs35mrespectively.2.The counts of peripheral leukocyte and blast cells were higher in adult ALLthan that of children ALL. There were significant differences among the three groupwith the number of leukocyte respectively,OS and DFS:＜10×109/L,(10-50)×109/Land＞50×109/L. The OS andDFS in the three group have significant differencesi.e.25.5m vs30mvs23m；20m vs28.8mvs17m.3.In the high-risk and medial-risk groups of ALL, the level of LDH (2032±544)was markedly elevated than that in the low-risk group (995.4±112.9) at diagnosis.The LDH levels were higher in complete remission (CR) than that at diagnosis in thethree groups.4. No statistical difference of OS was observed between B-cell and T-cell adultALL. The OS of pre-B-cell, B-cell and T-cell in children ALL were44,37and 18months respectively. There were significant differences in every two groups.5.The rate of chromosome abnormality in172ALL patients was23.1%and themost common is Ph chromosome. ALL paitents with Ph positive chromosome hadshorter OS than with normal chromosome (17m vs26m).There were significant differences of OS among all sub-groups in adult ALLpatiens. In children ALL sub-groups, marked differences of OS were observed and thelowest was paitens with complex chromosome aberrations (5.6m).6. The OS of L1, L2and L3were29m,31m and35m respectively. No statisticaldifference was found among the three groups.7. In172ALL patients, the fusion genes were examined including TCRV,BCR/ABL and TELL. There were no markedly differences among all sub-groups inadult ALL patiens. In children ALL patiens, significant statistical differences wereobserved among all sub-groups. The highest is the patient with normal chromosome(44.5m) and the lowest is with MELLgene aberration (17.5m).8. The medial-risk group of adult ALL patients had a longer OS thant thehigh-risk group (17.5m vs17m) according to MICM standards. The OS of low-risk,medial-risk and high-risk groups in children ALL were41m,38m and22mrespectively. There were significant differences in every two groups.9. The DFS in children ALL were higher than that in adult ALL (97.6%vs86.2%). ALL patients treated with a L-ASP-based regimen had an elevated OS thanthose without L-ASP regimen（20m vs13.5m, p=0.028), but the rate of CR both ofthem have undifferentiated(83.6%vs92.3，p=0.281). T-ALL patients treated withCTX-contained regimen were found to have a higher CR rate than those withoutCTX-contained regimen (87.5%vs33.3%).10. The DFS rate in adult ALL lower than in children group (P=0.000).Therelapse rate in adult ALL was higher than that in children ALL (60%vs15.7%).Central nervous system leukemia was observed in three adult ALL and two childrenALL cases.Conclusions:1. The adult ALL had poorer prognosis than the children ALL statistically. Theadult patients with ALL had lower DFS and lower OS and higher relapse rate than the children ALL patients.2. The peripheral leukocyte was observed to be higher in adult ALL than inchildren ALL. A negative correlation was found between the number of peripheralleukocyte and the OS in adult ALL patiens.3. In adult ALL, the examination of LDH level and the aberration of fuse geneswas of clinical significance to assess the outcome and monitor the state of disease.4.The OS of three immunophenotypes was T-ALL<B-ALL<pre-B-ALL.5.The bone marrow morphology was of limited significance in evaluating theprognosis of ALL patients.6.The most common chromosome aberration was Ph chromosome in ALL. TheALL patients wth Ph positive chromosome had a worse prognosis than with normalchromosome, indicating that chromosome aberration was an important index for ALLpatients’ prognosis.7.The MICM classification played a critical role in assessing the prognosis ofboth adult and children ALL patients.8.The L-ASP-base regimen can augment the OS for patients with ALL. TheCTX-contained regimen may possible improve the outcome of T-ALL patients. |
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