文章：

接受一线儿童启发式疗法治疗后复发的急性淋巴细胞白血病：一项回顾性 GRAALL 研究

Acute lymphoblastic leukemia relapsing after first-line pediatric-inspired therapy: a retrospective GRAALL study

原文发布日期：2016-12-09

DOI: 10.1038/bcj.2016.111

类型: Original Article

开放获取: 是

英文摘要：

The outcome of adult patients with Philadelphia chromosome-negative acute lymphoblastic leukemia (Ph− ALL) relapsing after pediatric-inspired front-line therapy is ill known. Here 229 relapsing Ph− ALL younger adults (18–63 years) treated within the Group for Research on Adult Acute Lymphoblastic Leukemia (GRAALL)-2003/-2005 trials were considered. Salvage regimens consisted of potentially curative therapies in 194 cases, low-intensity therapies in 21, allogeneic stem cell transplant (allo-SCT) in 6 and best supportive care in 8. Overall, 77 patients received allo-SCT after relapse. The median follow-up was 3.1 years. A second complete remission (CR2) was achieved in 121 patients (53%). In multivariate analysis, only younger age <45 years (P=0.008) and CR1 duration ⩾18 months (P=0.009) predicted CR2. Overall survival (OS) at 2 and 5 years was 19.3% (14–24%) and 13.3% (8–18%), respectively. In CR2 patients, disease-free survival (DFS) at 2 and 5 years was 29.0% (21–38%) and 25% (17–33%). In multivariate analysis, CR1 duration ⩾18 months and allo-SCT after relapse were associated with longer DFS (P<0.009 and P=0.004, respectively) and longer OS (P=0.004 and P<0.0001, respectively). In conclusion, although younger adults relapsing after pediatric-inspired ALL therapies retain a poor outcome, some of them may be cured if CR1 duration ⩾18 months and if allo-SCT can be performed in CR2. New therapies are definitely needed for these patients.

摘要翻译： 

费城染色体阴性急性淋巴细胞白血病（Ph− ALL）成年患者在接受儿童方案启发的一线治疗后复发的结局目前尚不明确。本研究纳入GRAALL-2003/-2005临床试验中229例复发的Ph− ALL年轻成人患者（18-63岁）。挽救治疗方案包括：194例接受潜在根治性治疗，21例接受低强度治疗，6例接受异基因干细胞移植（allo-SCT），8例接受最佳支持治疗。共有77例患者在复发后接受了allo-SCT。中位随访时间为3.1年。121例（53%）患者获得第二次完全缓解（CR2）。多变量分析显示，仅年龄<45岁（P=0.008）和首次缓解期（CR1）≥18个月（P=0.009）可预测CR2。患者2年及5年总生存率（OS）分别为19.3%（14-24%）和13.3%（8-18%）。达到CR2的患者2年及5年无病生存率（DFS）分别为29.0%（21-38%）和25%（17-33%）。多变量分析表明，CR1持续时间≥18个月与复发后接受allo-SCT均与更长的DFS（分别为P<0.009和P=0.004）和更长的OS（分别为P=0.004和P<0.0001）相关。结论表明，虽然接受儿童方案治疗后复发的年轻成人患者总体预后较差，但若CR1持续时间≥18个月且在CR2期能接受allo-SCT，部分患者仍可能获得治愈。这类患者无疑需要新的治疗策略。

原文链接：

Acute lymphoblastic leukemia relapsing after first-line pediatric-inspired therapy: a retrospective GRAALL study