The Clinical Analysis Of 102 Cases Of Adult In Patients With Philadelphia Chromosome Negative Acute Lymphoblastic Leukemia

Objective:Analysis of the relationship between clinical characteristics and curative effect in adult Philadelphia chromosome negative acute lymphoblastic leukemia patients.Methods:The clinical data of 102 patients with adult Ph~--ALL enrolled from November2013 to November 2018 were studied retrospectively.The relationship between clinical characteristics and curative effect was analyzed.The COX analysis was used to reveal the risk factors affecting the patients's OS time.Results:1.In 102 patients with initial Ph~--ALL,53 cases were male,49 cases were female,the proportion of men and women was 1.08:1,the median onset age was 35 years,and the clinical manifestations of anemia,fever,spleen,enlargement of lymph nodes,hemorrhage,sternum tenderness and large liver were mainly accompanied by 2 cases of central nervous system leukemia(CNSL).1 cases were accompanied by testicular infiltration.The median number of peripheral blood leukocyte(WBC)count was 11.92×10~9/L,of which WBC counted>100×10~9/L 15 cases,(30-100)×10~9/L 16 cases,<30×10~9/L 71 cases,hemoglobin(Hb)concentration median was 76.30g/L The median number of platelets(PLT)was 43.50×10~9/L,and the median proportion of bone marrow childish lymphocytes was 88.50%at the time of initial diagnosis.B-ALL 78 cases,T-ALL 24 cases.Cytogenetic analysis showed 87 cases of normal karyotype and 15 cases of abnormal karyotype.Gene mutations were accompanied by 22 patients.2.In 102 patients with initial Ph~--ALL,17 cases were induced by VCDP regimen,and 85cases were induced by VCDLP regimen,of which 81 cases reached CR,CR rate of79.41%.After CR,74 patients underwent continued consolidation therapy and 7 patients were treated with allogeneic hematopoietic stem cell transplantation.3.In 102 patients with initial Ph~--ALL,the sex,age of onset(bounded by 35 years of age),WBC count(B-ALL to 30×10~9/L as the boundary,T-ALL to 100×10~9/L as the boundary),whether with liver and spleen/lymph node enlargement,immunophenotype(B or T series),The proportion of bone marrow childish cells(bounded by 90%),the proportion of bone marrow childish cells induced by chemotherapy for 2 weeks(bounded by 0.075),whether the induced chemotherapy regimen included L-Asp and other factors were related to the CR rate of patients,and the results showed that the CR rate was higher in the group of 35 years old than?35 years(89.36%:70.91%).,P=0.022);The CR rate of the lower WBC count(B-ALL<30×10~9/L,T-ALL<100×10~9/L)was significantlyhigherthanthatofthosewithahigherWBCcount(84.38%:15.63%,P=0.033;83.33%:16.67%,P=0.017);CR rate is lower than that of non-companion(72.58%:90%,P=0.034)in patients with hepatic spleen/lymph node enlargement;The CR rate of bone marrow primitive cell proportion?0.075 group was significantly lower than that of<0.075 Group(64.10%:88.89%,P=0.003)after 2 weeks of induced chemotherapy.4.In 81 patients with CR,the median survival time was 15 months,39 cases had recurrence,the recurrence rate was 48.15%,the median time of recurrence was 8month,the OS rate in 3 years was 38.27%,and the DFS rate was 3 in 22.23%years.5.In 81 patients with CR,the relationship between OS rate and patients was analyzed,and the results showed that the OS rate of<35 years old group was higher than that of?35 years old group(35.3%:17.2%,p=0.009);the lower WBC count(B-ALL<30×10~9/L,T-ALL<100×10~9/L)The OS rate is significantly higher than the WBC count(B-ALL?30×10~9/L,T-ALL?100×10~9/L)(p=0.037;p=0.039).6.COX multi-Factor regression model analysis showed that the age of onset(P=0.010),the number of WBC at initial diagnosis(P=0.040)and 4 weeks induced chemotherapy amounted to CR(P=0.010)as independent prognostic factors affecting adult Ph~--ALL.Conclusion:1.The CR rate was higher when the age was small,the WBC count was low at the time of initial diagnosis,those who were not associated with liver and spleen/lymph node enlargement,and the proportion of bone marrow childish cells was lower after 2 weeks of induction chemotherapy.2.The age of onset,the WBC count at initial diagnosis,and the independent prognostic factors of 4 weeks of induction chemotherapy to the survival of adult Ph~--ALL patients.3.Positive acceptance of Allo-HSCT in patients with CR can improve the curative effect of adult Ph~--ALL patients.