Objective: To explore the efficacy and prognostic factors of imatinib(IM)combined with chemotherapy for BCR-ABL gene positive acute lymphoblastic leukemia(ALL). Methods: A total of 209 BCR-ABL+ALL patients treated with imatinib plus chemotherapy from April 2003 to August 2015 were enrolled in the study, and 106 patients underwent hematopoietic stem cell transplantation(HSCT). Results: The complete remission(CR)rate was 97.9% in newly diagnosed patients. WBC≥100×109/L at diagnosis was a poor factor for overall survival(OS)(P=0.043). Without HSCT, not achieved CR within 4 weeks in the first cycle induction chemotherapy and complete molecular remission(CMR)not achieved during the treatment were adverse factors for OS(P<0.001, P=0.009, P<0.001, respectively), as well as for relapse free survival(RFS)(P<0.001, <0.001 and <0.001, respectively). Of the 106 patients who underwent allo-HSCT or auto-HSCT, there was no statistically significant difference on the OS and RFS. There was no significant difference on OS in patients treated with imatinib or not in the induction chemotherapy, but the former showed higher 5-year RFS rate(37.0% vs 24.0%, P=0.005). The survival of the patients who took tyrosine kinase inhibitors(TKIs)regularly and continuously was the best(40 patients changed to other TKI due to relapse/unsatisfactory decrease in transcription level/occurrence of mutation), followed by those who interrupted TKIs during the bone marrow suppression, those who took TKIs irregularly the worst. The 5- year OS rates among three groups were 46.0%, 28.0% and 17.0%, respectively(P=0.004). The 5- year EFS rates among three groups were 38.0%, 28.0% and 17.0%, respectively(P<0.001). Conclusion: TKIs plus chemotherapy followed by HSCT improved the prognosis of the patients with BCR-ABL+ALL patients. It is important to administer TKIs regularly and continuously to improve the outcome of BCR-ABL+ALL patients.
目的: 探讨真实世界中伊马替尼(IM)联合化疗治疗BCR-ABL阳性急性淋巴细胞白血病(ALL)的疗效及相关预后因素。
方法: 2003年4月至2015年8月收治的209例治疗中包含IM的BCR-ABL阳性ALL患者纳入研究，106例患者接受造血干细胞移植(HSCT)。对患者的疗效和预后影响因素进行分析。
结果: 初诊患者诱导完全缓解(CR)率为97.9%。初诊时WBC≥100×109/L是总生存(OS)的不良预后因素(P=0.043)。未接受HSCT、诱导治疗4周内未达CR和治疗过程中未达到分子生物学完全缓解(CMR)是OS(P值分别为<0.001、0.009和<0.001)和无复发生存(RFS)(P值均<0.001)的不良预后因素。接受异基因HSCT和自体HSCT的患者，其OS和RFS的差异均无统计学意义(P值均>0.05)。首次诱导治疗时联用IM的患者较未联用者显示出更高的5年RFS率(37.0％对24.0%，P= 0.005)。在治疗过程中持续规律服用酪氨酸激酶抑制剂(TKI，40例患者由于复发、转录本水平下降不理想或出现突变换用其他TKI)的患者生存情况最佳，其次为骨髓抑制期间断停用TKI的患者，不规律服用TKI的患者生存情况最差，三组5年OS率分别为46.0%、28.0%、17.0%(P=0.004)，5年RFS率分别为38.0%、28.0%、17.0%(P<0.001)。
结论: TKI联合化疗获得CMR，序贯以HSCT可改善BCR-ABL阳性ALL患者预后，持续规律地联用TKI有助于BCR-ABL阳性ALL患者疗效的提高。