| Objective:(1) To investigate the clinical and biological characteristics of adult B-ALL, analyzethe relationship between the clinical efficacy and prognosis, with the hope of furtherproviding the basis for treatment of adult B-ALL patients.(2) To observe and analyze the clinical efficacy of66allogeneic hematopoietic stemcell (allo-HSCT) in adult patients with Ph+ALL, and explore its therapeutic strategies.Materials and Methods:(1) We retrospectively analyzed354adult B-ALL patients (more than14years old)whose diagnosis was investigated in our hospital from June2006to September2013. Bonemarrow morphology, immunophenotype, bone marrow chromosome and fusion genes wereexamined on all patients. We analyzed the clinical and biological characteristics ofdifferent types of patients and assessed the relationship between these features and theprognosis. We divided all patients into two groups by the MICM to assess the prognosis.(2) We retrospectively analyzed66adult Ph+ALL patients who received allo-HSCT inour hospital from June2006to September2013, including23matched sibling (MSD)HSCT,22matched unrelated (MUD) HSCT and21related haplo-HSCT. All patientsreceived myeloablative pretreatment conditioning regimen. Follow-up observation lastedtill September2013, and we compared three groups of transplantation methods on theclinical efficacy to treat adult Ph+ALL (such as hematopoietic reconstitution, incidence ofGVHD, recurrence rate, OS rate,etc).Results:(1)354cases of adult B-ALL patients were classified by FAB classification;110,162,11and71cases were diagnosed as L1, L2, L3and NOS respectively (not otherwise specified). Age of onset for L1was significantly lower than that of L2; WBC count of L2was significantly higher than those of L1and L3; LDH level of L3was significantly higherthan any other groups (P<0.05). Survival analysis was conducted on263cases of patients,and we found no significant difference between the overall survival (OS) among the aboveL1, L2, L3and NOS (P>0.05).(2) he rates of354adult B-ALL patients with myeloid antigen expression (My+) andCD34+were51.98%and72.32%. Compared with the My-, CD34-group respectively, adultB-ALL with My+, CD34+showed no significant differences in prognosis (P>0.05).(3) Combination of cell genetics and molecular biology has greatly improved thedetection rate of abnormal karyotype. Patients with t (9;22)/BCR-ABL, t (4;11)/MLL-AF4, t (1;19)/E2A-PBX1had poor prognosis and high recurrence rate. Theirmedian OS were26months,18months,14months, while patients with t (8;14)/c-mycafter sequential treatment had good prognosis, and the median OS was40months.(4) All patients were classified by MICM classification and prognostic analysis intostandard-risk and high-risk groups. The standard-risk group was found to have a lowerrecurrence rate than the high-risk group (26.23%vs41.58%,P <0.05). Patients in thestandard-risk group had a longer OS than the high-risk group (45months vs25months, P<0.05).(5) Haplo-HSCT patients achieved hematopoietic reconstitution slowly thanHLA-matched HSCT. There was no significant statistic difference in incidence of GVHD,incidence of relapse and TRM among three groups (P>0.05).(6) There were51CR1patients before transplant. The rate of3-year OS afterallo-HSCT was72.7%and the rate of relapse was11.76%. There were15rather than CR1patients; the rate of3-year OS of patients who received allo-HSCT in non-CR1was36.9%and the recurrence rate was46.67%. There was significant difference in the rate of OS andthe recurrence rate between two groups (P<0.05).(7) The rate of3-year OS and DFS of66adult Ph+ALL patients who receivedallo-HSCT were63%and57.3%. Matched unrelated transplantation yielded the besteffect. In23MSD-HSCT, the rate of2-year and3-year OS were77%and61.6%. In22MUD-HSCT, the rate of2-year and3-year OS were55.3%and36.8%. In21haplo-HSCTpatients, the rate of2-year OS was59%. Conclusions:(1) FAB classification guidance and immunepheno type played limited significancein evaluating the prognosis of adult B-ALL patients.(2) Abnormal cell cytogenetics and molecular biology were important clinicalindicators to evaluate the prognosis of adult B-ALL patients. Patients with t (9;22)/BCR-ABL, t (4;11)/MLL-AF4, t (1;19)/E2A-PBX1had a poor prognosis.(3) The MICM classification played an important role to evaluate the prognosis ofadult B-ALL patients.(4) Allo-HSCT is an effective treatment for adult Ph+ALL patients.(5) Audlt Ph+ALL patients should receive allo-HSCT in CR1as soon as possible, forthe efficacy would be much better than the late period.(6) Related haplo-HSCT is a feasible and effective approach in treatment of adultPh+ALL patients, without a HLA-matched related or unrelated donor. |
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