| Objective To analyze the clinical characteristics of adult acute lymphoblastic leukemia (ALL), compare the efficacy of different therapeutic regimens and explore the relevant prognostic factors.Methods The clinical data of219adult ALL patients hospitalized in our institute between January2005and July2011were retrospectively reviewed. The results were analyzed with the SPSS18.0software.Results1. Clinical features:a total of219patients between15and65years of age (median26yr) were enrolled, including146cases of male and73cases of female.171patients had available immunophenotype data,70.2%of them were B-ALL, and27.5%were T-ALL, only1.8%bi-phenotype. In addition,51.5%of the patients with positive CD34expression, and38.0%with myeloid antigen expression. Of135patients with cytogenetic examination,74cases were normal karyotype,61cases were chromosome aberrations, and23cases were Ph+. The incidence of high WBC in T-ALL was higher than B-ALL (65.2%vs44.1%, P=0.0010). 2. Treatment analysis showed a total remission rate of89.3%, and recurrence proportion of52.6%.134patients had chemotherapy based on VDCP scheme, while85patients based on Hyper-CVAD scheme,56patients received hematopoietic stem cell transplantation (HSCT).3. Survival analysis showed that:3years of expected DFS rate and OS rate were22.8%and23.1%for204patients. For the group which induction chemotherapy could achieve complete remission (CR) and not, the3years of OS rate were27.9%and0%, respectively (P=0.0000), and DFS rate were22.8%and0%, respectively (P=0.0000). In another two groups that were to continual conventional chemotherapy after CR for more than four treatments or less than that,3years of expected OS rate were significantly different (15.2%vs25.3%, P=0.0050). Two types of treatments after CR1were supplied, that were transplantation and continual chemotherapy. The DFS rate in the transplantation group was higher than chemotherapy group (45.9%vs18.6%, P=0.0000). And3years expected OS rates in the two groups also had significant difference (45.0%vs17.1%, respectively, P=0.0050). Patients failed to achieve CR by induction chemotherapy died within2years.4. Univariate analysis showed that:age of onset, WBC count when first visit, immunophenotype, the status of CD34expression, whether achieved CR or not after induction chemotherapy and whether had a stem cell donor or not could be considered as prognostic factors for adult ALL. Multivariate analysis showed that:older age, lower expression of CD34, and the condition of not ease by induction chemotherapy were some independent risk factors affected the long-term survival of ALL patients.5. Analysis of cause of death showed that:recurrence was the leading cause of death for adult ALL. The causes of death related to treatments were mainly infection in the chemotherapy group, and graft versus host disease (GVHD) as well as infection in the transplantation group.Conclusion1. CR rate after chemotherapy was high for Adult ALL, but OS rate was low by contraries. It could improve the long-term survival to continue to consolidate maintenance treatment after CR.2. Allo-HSCT could improve further the curative effect during CR1period.3. Recurrence and infection during treatment were still the leading causes of death for adult patients with ALL. Meanwhile, GVHD was still the important factor resulting in death after transplantation.4. Older age, low expression of CD34and not CR after induced chemotherapy were independent poor risk factors of the patients’long-term survival. |
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