| ObjectiveRetrospective analysis the clinical features and treatment efficacy of adult Ph-positiveALL, to observe the curative effect and safety of TKI combine chemotherapy ininduction period, Analysis effect of different time application TKI on disease curative.Confirm the Allo-HSCT to the curative effect of the disease, comparing the influence ofdifference state before transplantation, analysis of the main causes of death in patients,and explore the safe and effective treatment, provides the treatment basis for the clinicaltreatment.MethodsBetween April2007and April2012,63patients were diagnosed with Ph-positive ALL.We divided these patients into two groups according to whether apply TKI or not duringthe period of induction. A total of26cases were in chemotherapy+TKI group,chemotherapy group were37cases. We divided46cases into different group accordingto start application timing,26cases were in induction period,4cases were inconsolidation period, and16cases were in recurrence and refractory state. the46patients were divided into non save group (N=30) and save (N=16), the not savegroup were divided into Allo-HSCT group (N=21) and not Allo-HSCT group (N=9),the save group were divided into Allo-HSCT group (N=11) and not Allo-HSCTgroup (N=5),the chemotherapy group (N=17) were divided into Allo-HSCT group(N=7), and the not Allo-HSCT group (N=10). The state of Pre-transplant in CR126patients,13cases in CR2or higher state. Analysis the side effects of TKI combinedchemotherapy group and chemotherapy group. Analysis the cause of death in patientswith constituent ratio.ResultsThe CR rate of Induction period in Group Chemotherapy+TKI and group chemotherapy were respectively96.2%(25/26) and81.1%(30/37)(P=0.17). Not savegroup5years OS rate was (76.2±8.7)%, the group is significantly higher than savegroup5years OS rate (30.0+1.8)%(P=0.01).Not save group (N=30) according to whether received Allo-HSCT points Allo-HSCTgroup (N=21) and the Allo-HSCT group (N=9), two groups of4years OS wererespectively (86.8±8.9)%and (47.6±1.8)%(P=0.01). Save group (N=16)according to whether received Allo-HSCT points Allo-HSCT group (N=11) and theAllo-HSCT group (N=5), two groups of5years OS were respectively (39.6±9.8)%and (22.9±10.2)%(P=0.15).The TKI group: according to whether the Allo-HSCTdivided into Allo-HSCT group (N=7), the Allo-HSCT group (N=10),3years OS oftwo groups were respectively (44.2±10.6)%and (12.6±3.7)%(P=0.04). Whetherapplication TKI, Allo-HSCT patients were significantly benefit from it. The5years OSof CR1group (N=26) and not CR1group (N=13) were respectively (80.6±0.8)%and(28.8±15.2)%(P=0.007). The CR1State before transplantation can obtain highersurvival.Multiple factors analysis showed that the independent impact factors of prognosis wereAllo-HSCT and TKI application timing. Occurrence of adverse events occurs duringchemotherapy III to IV: the incidence of chemotherapy group was41.2%(7/17), theincidence of chemotherapy+TKI group was60.9%(28/46)(P=0.16).The recurrencemortality of CR1group was7.7%(2/26) below the not CR1group recurrence mortality(P=0.009).ConclusionTKI combined with chemotherapy can obtain satisfactory CR rate. start the applicationsof TKI under state of recurrence and refractory still obtain satisfactory rate of CR.Regardless of whether application TKI or not, Allo HSCT can prolong the survival timeof patients, but the group of refractory and recurrent patients can’t get higherlong-term survival even though receive the treatment of Allo-HSCT. While theapplication of TKI combine chemotherapy as soon as possible and receive Allo HSCTcan obtain the longest survival time.Chemotherapy combined with TKI make patients get CR1as soon as possible and theearly implementation of Allo-HSCT can improve the survival rate of patients. Multiplefactors analysis showed that the independent impact factors of prognosis were Allo-HSCT and TKI application timing. Standard chemotherapy joint or not joint TKIare both have high incidence of serious adverse reaction, the state of not CR1beforetransplantation increased the risk of death. |
PDF Full Text Request