bcr-abl阳性急性淋巴细胞白血病分子生物学特点及预后分析

Objective To explore the molecular biological characteristics of bcr - abl positive acute lymphoblastic leukemia and its clinical efficacy and prognosis under the current treatment conditions. Methods The data of 35 newly diagnosed patients with bcr - abl positive acute lymphoblastic leukemia admitted from March 2009 to March 2014 were retrospectively analyzed. The differences in the time to achieve the first complete remission (CR), survival and recurrence among different chemotherapy regimens, different transcripts and between transplantation and non - transplantation were compared to evaluate the clinical efficacy and prognosis. Results Among the 35 newly diagnosed patients with bcr - abl positive acute lymphoblastic leukemia, there were 21 males and 14 females, with a median age of 38 years (ranging from 16 to 65 years), and a median white blood cell count of 29.5×10⁹/L (ranging from 1.33×10⁹/L to 192.45×10⁹/L). There were 26 cases (74.28%) with positive transcript p190, with a median relative mRNA expression level of 0.5824 (ranging from 0.1233 to 0.9760), and 9 cases (25.72%) with positive transcript p210, with a median relative mRNA expression level of 0.6235 (ranging from 0.0974 to 0.9592). The median follow - up was 12 months. The 35 newly diagnosed patients were treated with 4 different induction chemotherapy regimens combined with imatinib. There was no statistically significant difference in the time to achieve CR among the four different chemotherapy regimens (P = 0.518); the time to achieve CR in the patients with positive transcript p190 was longer than that in the patients with positive transcript p210 (P = 0.016), but there was no statistically significant difference in overall survival (P = 0.167) and recurrence (P = 0.164) between the two groups. Sixteen patients underwent allogeneic hematopoietic stem cell transplantation after chemotherapy remission. The median survival time in the transplantation group was 32 months (ranging from 7 to 43 months), and that in the non - transplantation group was 13 months (ranging from 4 to 18 months) (P = 0.017), but there was no statistically significant difference in the recurrence rate (P = 0.072). Conclusions Under the condition of combined imatinib treatment, different induction chemotherapy regimens have no significant impact on the efficacy and prognosis of bcr - abl positive acute lymphoblastic leukemia. The efficacy of patients with positive transcript p190 is worse than that of patients with positive transcript p210, but there is no difference in overall survival and recurrence rate; allogeneic hematopoietic stem cell transplantation significantly prolongs the survival time of patients.

目的 探讨 bcr．abl阳性急性淋巴细胞白血病的分子生物学特点以及在目前治疗条件下的临床疗效和预后 。方法 回顾性分析 2009年 3月至 2014年 3月收治 的35例初发 bcr-abl阳性急性淋巴细胞白血病患者资料，比较不同化疗方案、不同转录本及移植与非移植之间达到第一次完全缓解(CR)时间、生存及复发的差异 ，评价临床疗效及预后。结果 35例初发bcr—ahl阳性急性淋巴细胞白血病患者中，男性 21例 ，女性 14例，中位年龄 38岁 (16—65岁 )，白细胞计数中位水平 29．5×10／L(1．33X109／L一192．45×10／L)。转录本 p190阳性 26例(74．28％)，mRNA中位相对表达水平 0．5824(0．1233—0．9760)，p210阳性 9例 (25．72％)，mRNA中位相对表达水平 0．6235(0．0974～0．9592)。中位随访 12个月。35例初发患者采用 4种不同的诱导化疗方案联合伊马替尼进行治疗，四组不同化疗方案达到 CR。时间差异无统计学意义 (P=0．518)；转录本 p190阳性组患者达到 CR 时间较转录本p210阳性组患者延长 (P=0．016)，但两组总生存 (P=0．167)及复发 (P=0．164)均差异无统计学意义。16例患者化疗缓解后进行了异基 因造血干细胞移植 ，移植组中位生存时间 32个月 (7—43个月 )，非移植组中位生存时间 13个月 (4～18个月 )(P=0．017)，但复发率差异无统计学意义 (P=0．072)。结论 在联合伊马替尼治疗条件下，不同诱导化疗方案对 bcr-abl阳性急性淋巴细胞白血病疗效及预后无明显影响，转录本 p190阳性患者疗效较转录本 p210阳性患者差 ，但总生存与复发率无差异；异基因造血干细胞移植明显延长了患者的生存 时间。.