The Efficacy And Prognosis Analysis Of Adult Acute Lymphoblastic Leukemiawith Children's Regimen

Objectives: In this study,we retrospectively analyzed the clinical datas of adults with acute lymphoblastic leukemia(ALL)using children's regimen or adult's regimen.And we analyzed the recent and long-term efficacy.Methods: Wecollected the data of 35 cases of adult ALL patients for the children's regimen treatment group and 20 cases of adult ALL patientsfor the adult's regimen treatment group from January 18,2011 to January 18,2014 in Department of Hematology of the Second Affiliated Hospital of Dalian Medical University.We collected clinical information of patients includingage,sex,date of diagnosis,diagnosis of disease,initial diagnosis of symptoms,the initial diagnosis of blood,primitive cell percentage of bone marrow,chromosome karyotype analysis,immunophenotypingand fusion gene and other laboratory results.We cleared the risk stratification,ECOG score,treatment plan,the first time to induce remission of CR(complete remission)of each patient.We observed the side effects of chemotherapy drugs,infection,survival,disease-free survival,death and so on.We used SPSS16.0 statistical software for analysis.P <0.05 was statistically significant.Results: 1.General characteristics: Children's regimen group: There were 35 patients in this group,which the median age was 33(16-56)months,male to female ratio was 1: 1.2.There were 18 cases(51%)in the standard group and 17 cases(49%)in the high risk group.There were 32 cases(91%)of B-ALL,3 cases(9%)of T-ALL.Adult's regimen group: There were 20 patients in this group,whichthe median age was 33.5(15-57)months,male to female ratio was 1:1.2.There were 15 cases(75%)in the standard group and 5 cases(25%)in the high risk group.There were 16 cases(80%)of B-ALL,4 cases(20%)of T-ALL,2.Efficacy: Children's regimen group: The CR rate of 35 cases of adult ALL with the first regimen to induce chemotherapy was 91%,NR(non remission)rate was 9%.The CR1 time <4 weeks of patients accounted for 71%,?4 weeks accounted for29 %.14 cases(44%)recured except for 3 cases of hematopoietic stem cell transplantation.Adult's group: The CR rate of 20 cases of adult ALL using the adult's regimen for the first time to induce chemotherapy was 70%,NR rate was30%,which reached CR1 time <4 weeks of patients accounted for 71%,?4 weeks accounted for 29%.13 cases(65%)recurrence occurred.The CR rates were 91% and 70%,respectively,in the children's regimen group and the adult's group.The difference was statistically significant(P=0.039).The CR rate was 94% for the first time in 16 patients with age?35 years in children's regimen group and the first CR rate was 29% in 7 patients aged?35 years in adult's group.The difference was statistically significant(P=0.001).The CR rate was 90% for the first time in the 10 patients with leukocyte?30×10 9/L(B-ALL)in children's regimen group,and the first induction CR rate was 33% in 6 patients with leukocyte?30×109/L(B-ALL)in the adult's group.The difference between the two groups(P=0.018)was statistically significant.3.Survival:Children's regimengroup:32 cases(47%)survived,17 cases(53%)died,the median survival time was 38(0.5-57)months,the 3 years OS was 54%,the 3 years DFS rate was 53% except for 3 cases with hematopoietic stem cell transplantation.Adult's group: There were twenty patients in this group,which 6 cases(30%)survived,14 cases(70%)died,the median survival was 19.5(1-45)months,the 3 years OS rate was 30%,the 3 years DFS rate was 30%.The difference of 3-year OS between the two groups was statistically significant(P=0.023),and the difference of 3-year DFS was not statistically significant(P= 0.102).Conclusion: In summary,children's regimen was better than adult's regimen for adult ALL patients which induced remission rate and 3-year OS rate and DFS rates were significantly increased.The remission rate of more than 35 years of age,the incidence of WBC ? 30 × 109/L induction and the rate of remission of children's regimen groupwerehigher than that of adult's regimen group.Adults were better tolerated for children's chemotherapy regimen,but the toxicity of chemotherapy was greater than that of children's.Treatment should be taken to strengthen the prevention of infection and we should use the anti-infective treatmenttimely.