本文選題：急性淋巴細(xì)胞　切入點(diǎn)：白血病　出處：《大連醫(yī)科大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：目的:回顧性分析大連醫(yī)科大學(xué)附屬第二醫(yī)院血液科成人急性淋巴細(xì)胞白血病(acute lymphoblastic leukemia,ALL)應(yīng)用兒童方案及成人方案的病例的臨床資料和治療療效,比較并分析兩者的預(yù)后。方法:收集2011年1月18日-2014年1月18日大連醫(yī)科大學(xué)附屬第二醫(yī)院血液科35例應(yīng)用兒童方案及20例應(yīng)用成人方案的初發(fā)成人ALL,統(tǒng)計(jì)患者的臨床信息,包括年齡、性別、確診日期、疾病診斷、發(fā)病情況,記錄初診時(shí)血常規(guī)、骨髓原始細(xì)胞比例、染色體分析、免疫學(xué)分型及融合基因等實(shí)驗(yàn)室檢查結(jié)果,明確每個(gè)病人的危險(xiǎn)度分層、ECOG評分、治療方案、第一次誘導(dǎo)緩解達(dá)CR(complete remission)時(shí)間,觀察化療藥物副反應(yīng)、感染情況、生存期、無病生存期、死亡原因等。采用SPSS16.0統(tǒng)計(jì)學(xué)軟件分析結(jié)果。P0.05具有統(tǒng)計(jì)學(xué)意義。結(jié)果:1.一般特征:兒童方案組:入組35例患者,男:女=1:1.2,中位年齡33(16-56)歲。其中標(biāo)危組18例(51%),高危組17例(49%)。B-ALL 32例(91%),T-ALL 3例(9%)。成人方案組:入組20例患者,男:女1:1.2,中位年齡33.5(15-57)歲。其中標(biāo)危組15例(75%),高危組5例(25%)。B-ALL 16例(80%),T-ALL 4例(20%),2.療效:兒童方案組:35例成人ALL采用兒童方案首次誘導(dǎo)化療CR率91%,NR(non-remission)率9%,達(dá)CR1所用時(shí)間4周患者占71%,≥4周占29%。除外3例采用異基因造血干細(xì)胞移植(Allo-HSCT)外,其他32例中有14例(44%)出現(xiàn)復(fù)發(fā)。成人方案組:20例成人ALL采用成人方案首次誘導(dǎo)化療CR率(70%),NR率30%,其中達(dá)CR1所用時(shí)間4周的患者占71%,≥4周占29%,13例(65%)出現(xiàn)復(fù)發(fā)。兒童方案組與成人方案組首次誘導(dǎo)化療后達(dá)CR率分別為91%和70%,兩組間對比有統(tǒng)計(jì)學(xué)差異(P=0.039)。兒童方案組年齡≥35歲的16例患者首次誘導(dǎo)CR率為94%,成人方案組≥35歲的7例患者首次誘導(dǎo)CR率為29%,兩者差異(P=0.001)有統(tǒng)計(jì)學(xué)意義。兒童方案組白細(xì)胞(white blood cell,WBC)≥30×109/L(B-ALL)的10例患者首次誘導(dǎo)CR率為90%,成人方案組WBC≥30×109/L(B-ALL)的6例患者首次誘導(dǎo)CR率為33%,兩者差異(P=0.018)有統(tǒng)計(jì)學(xué)意義。3.生存率:兒童方案組:除外3例采用Allo-HSCT患者,其余成人ALL采用兒童方案規(guī)律化療,其中15例(47%)存活,17例(53%)死亡,中位生存期38(0.5-57)月,3年OS率為60%,3年DFS率為53%。成人方案組:20例成人ALL采用成人方案規(guī)律化療,其中6例(30%)存活,14例(70%)死亡,中位生存期19.5(1-45)月,3年OS率為30%,3年DFS率為30%。兩組3年OS率差異有統(tǒng)計(jì)學(xué)意義(P=0.023),3年DFS差異無統(tǒng)計(jì)學(xué)意義(P=0.102)。結(jié)論:對初發(fā)成人ALL的治療,兒童方案與成人方案對比,誘導(dǎo)緩解率、3年OS率及DFS率均明顯增高,對年齡大于35歲、發(fā)病時(shí)WBC≥30×109/L患者的誘導(dǎo)緩解率較成人方案高。因此,治療成人ALL,兒童方案療效優(yōu)于成人方案。成人對兒童化療方案耐受較好,但對化療毒副反應(yīng)較兒童大,治療中應(yīng)注意強(qiáng)化預(yù)防感染。
[Abstract]:Objective: to retrospectively analyze the clinical data and therapeutic effect of acute lymphoblastic leukemia (ALL) in the Department of Hematology, Department of Hematology, second affiliated Hospital of Dalian Medical University. Methods: from January 18th 2011 to January 18th 2014, the clinical data of 35 children's and 20 newly diagnosed adult ALL patients who were treated with the second affiliated Hospital of Dalian Medical University were collected, and the clinical data of the patients were analyzed. These include age, sex, date of diagnosis, diagnosis of disease, incidence, recording of blood routine at first visit, proportion of bone marrow primordial cells, chromosome analysis, immunological typing and fusion gene. To determine each patient's risk stratification score, treatment plan, first induced remission time to CR(complete remission. to observe the side effects of chemotherapy drugs, infection, survival time, disease-free survival. Cause of death and so on. Using SPSS16.0 statistical software analysis results. P0.05 has statistical significance. Results: 1. General characteristics: children program group: 35 patients into the group, Male: female: 1: 1.2, median age: 3316-56). 18 cases of risk group, 17 cases of high risk group, 17 cases of high risk group, 32 cases with 91D T-ALL, 3 cases with T-ALL. Male: female 1: 1.2, median age: 33.5- (15-57) years old. 15 cases in the risk group and 5 cases in the high risk group, 5 cases in the high risk group, 5 cases in the high risk group, 16 cases in the high risk group, 16 cases in the high risk group, and 20 cases in 20 cases. 2. Curative effect: children's program group, 35 adults, ALL, the CR rate of the first induction chemotherapy in children's regimen 91nRruremission.The response rate is 9, and the time taken to reach CR1 is 4 weeks. Except for 3 cases with allogeneic hematopoietic stem cell transplantation (Allo-HSCT), Of the other 32 cases, 14 cases had recurrence. In the adult program group, 20 adult patients with ALL received the first induction chemotherapy with adult regimen, the CR rate was 70% and NR rate was 30%. The patients who had reached CR1 for 4 weeks accounted for 71% of them, and more than 4 weeks for 29 cases (13 cases). The CR rates of the first induction chemotherapy group and the adult group were 91% and 70, respectively. There was a significant difference between the two groups. The CR rate of 16 patients with age 鈮，

本文編號：1601670