Clinical analysis of 52 cases of adult patients with Philadelphia chromosomal-positive acute lymphoblastic leukemia

Abstract

Objective To explore the efficacy and prognostic factors of induction therapy in adult patients with Philadelphia chromosome-positive acute lymphoblastic leukemia (Ph+ ALL). Methods From November 2013 to November 2018, a total of 52 newly diagnosed adult patients with Ph+ ALL who admitted to the Department of Hematology, Second Hospital of Shanxi Medical University were included in this study. According to different induction treatment regimens, they were divided into chemotherapy combined with tyrosine kinase inhibitor (TKI) group (n=33) and chemotherapy alone group (n=19). Retrospective analysis method was used to collect the complete remission (CR) rate, no complete remission (NR) rate, recurrence rate, prognosis, and the influencing factors of prognosis in adult patients with Ph+ ALL. The chi-square test was used to compare the CR rates between two groups. The Kaplan-Meier method was used to draw the survival curves. Univariate analysis was performed by Log-rank test to determine the influencing factors affecting the prognosis of patients, such as gender, age, hepatosplenomegaly and white blood cell count and so on. Statistically significant factors and factors with clinical guiding significance in the univariate analysis were included in the Cox proportional hazard regression model for multivariate analysis. The follow-up period was up to November 30, 2018. The procedure of this study was accordance with the requirement of the revised World Medical Association Declaration of Helsinki in 2013. Informed consent was obtained from all participants. Results ① Among the 52 patients with newly diagnosed Ph+ ALL, 36 patients (69.2%) achieved CR and 16 patients (30.8%) achieved NR after 4 weeks induction therapy. The CR rate was 83.3% (30/33) in the chemotherapy combined with TKI group, which was higher than that of 16.7% (6/19) in the chemotherapy alone group, and the difference was statistically significant (χ2=17.237, P<0.001). ② The recurrence rate of the 52 patients in this study was 69.2% (36/52), and the median time to recurrence was 9 months (1-49 months). ③ The median survival time of the 52 patients in this study was 11 months(4-52 months), the 1-year overall survival (OS) rate was 42.3%, and the 1-year event-free survival (EFS) rate was 32.8%. ④ Results of univariate analysis showed that the median EFS rate and OS rate of patients with TKI were 11.0% (95%CI: 9.3%-12.7%) and 11.0% (95%CI: 10.1%-11.8%), respectively, which were higher than those of 6.0% (95%CI: 5.0%-7.0%) and 9.0% (95%CI: 7.6%-10.4%) in patients without TKI, and the differences were statistically significant (χ2=19.021, P<0.001; χ2=11.894, P<0.001). The median EFS rate and OS rate of CR patients after 4 weeks induction chemotherapy were 10.0% (95%CI: 7.7%-12.4%) and 11.0% (95%CI: 10.3%-11.9%), respectively, which were higher than those of 6.0% (95%CI: 4.7%-7.3%) and 9.0% (95%CI: 7.0%-11.0%) in NR patients, the differences were also statistically significant (χ2=15.447, P<0.001; χ2=11.139, P=0.001). ⑤ Cox multivariate analysis showed that combination of TKI was an independent protective factor for EFS rate (HR=0.370, 95%CI: 0.157-0.872, P=0.023) and OS rate (HR=0.321, 95%CI: 0.156-0.660, P=0.002) in adult patients with Ph+ ALL. Conclusions The combination of TKI in the induction therapy of adult patients with Ph+ ALL may improve the therapeutic effect of patients and improve the prognosis of them. Key words: Philadelphia chromosome; Precursor cell lymphoblastic leukemia-lymphoma; Protein-tyrosine kinases; Prognosis; Influencing factors