Objective: To investigate the prognostic significance of proportion of the blasts in bone marrow on day 14 (D14) during induction chemotherapy in patients with adult Ph-negative acute lymphoblastic leukemia (Ph (-) ALL).
Methods: Newly diagnosed Ph (-) ALL patients with bone marrow morphology analysis on day 14 during induction chemotherapy were analyzed retrospectively. The proportion of the D14 blasts which had an impact on achieving a CR by the first induction chemotherapy and outcomes were determined by ROC curve.
Results: 166 ALL patients including 94 male and 72 female were analyzed. The median age was 32 years (range, 18-64 years). The CR rate by the first induction chemotherapy was 74.7% with a total CR rate as 93.3%. By ROC analysis, 7.5% of the D14 blasts had the best sensitivity and specificity. The patients with D14 blasts ≥7.5% had lower CR rates after the first and overall induction chemotherapy compared with those with D14 blasts <7.5% (42.7% vs 85.9%, P<0.001 and 75.9% vs 95.6%, P=0.001 respectively). The probabilities of 5-year disease free survival (DFS) and 5-year overall survival (OS) were higher in the patients with D14 blasts<7.5% than those with D14 blasts ≥7.5% (49.8% vs 29.6%, P=0.006 and 52.4% vs 32.6%, P=0.010 respectively). Multivariate analysis showed that higher WBC or central nervous system leukemia at diagnosis, D14 blasts ≥7.5%, no CR after the first induction chemotherapy and receiving consolidation and maintenance chemotherapy rather than transplant were associated with poor outcomes.
Conclusions: Higher proportion of D14 blasts in bone marrow during the first induction therapy indicated poor prognosis in adult Ph(-) ALL.
目的: 探讨成人Ph染色体阴性急性淋巴细胞白血病（Ph−ALL）诱导治疗第14天（D14）骨髓原始细胞比例与获得完全缓解（CR）和预后的关系。
方法: 回顾分析166例初治Ph−ALL患者，通过ROC曲线确定影响诱导治疗4周达CR的D14骨髓原始细胞比例。
结果: 166例Ph−ALL患者，男94例，女72例，中位年龄32(18~64）岁。诱导治疗4周CR率为74.7%，总CR率为93.3%。存活者中位随访32(2~175）个月，5年无病生存（DFS）和总体生存（OS）率分别为45.6％和47.2%。D14骨髓原始细胞≥0.075组与<0.075组相比，4周CR率（42.7％对85.9%，P<0.001）和总CR率（75.9％对95.6%，P=0.001）显著降低，5年DFS率（29.6％对49.8%，P=0.006）和OS率（32.6％对52.4%，P=0.010）均显著降低。多因素分析显示，发病时高白细胞计数、存在中枢神经系统白血病、D14骨髓原始细胞≥0.075、诱导治疗4周未达CR、CR后接受化疗而非移植是影响DFS和OS的不利因素。
结论: 成人Ph−ALL患者诱导化疗D14骨髓原始细胞比例较高是影响获得CR和总体预后的不利因素。