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YENİ TANILI ERİŞKİN AKUT LENFOBLASTİK LÖSEMİ HASTALARINDA TOTAL SAĞKALIMI ETKİLEYEN FAKTÖRLER

THE FACTORS INFLUENCING OVERALL SURVIVAL IN NEWLY DIAGNOSED ADULT ACUTE LYMPHOBLASTIC LEUKEMIA PATIENTS

Journal Name:

  • İstanbul Tıp Fakültesi Dergisi

Publication Year:

  • 2011

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Keywords (Original Language):

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Abstract (2. Language): 
Objective: The prognosis of patients with acute lymphoblastic leukemia (ALL), treated with modern chemotherapeutic regimens, is dependent on a number of variables. Determination of these factors is crucial for adapting post remission therapy in adult ALL. We herein, stutried to explore the clinical characteristics of adult ALL and analyze the prognostic factors. Materials and methods: Data of 65 newly diagnosed adult ALL patients hospitalized in our institute between January 2003 and December 2008 were retrospectively reviewed. Median age was 35, 6 (range 16-74) and, 70% had B-lineage ALL, 20% had T-lineage ALL and 10% had Burkitt ALL. Thirty-two patients received Hyper-CVAD, 25 received CALGB-881, 3 received HAM (High dose ARA-C and Mithoxantrone), one received MOPP, one received St Jude Total XIII and one received CHOP-21. One patient had complete remission with CLAGB-881 but due to liver toxicity was maintained with Hyper-CVAD regimen. One patient died before treatment. Results: The mean follow-up time was 407 (0-1706) days. Cytogenetic analysis was performed in all patients, 9 cases of them had t(9;22), 2 had t(4;11) and one had myc-oncogen. The response rates in patients after the induction regimens; 60% (n=39) achieved complete remission (CR), 32% (N=21) died during induction (induction mortality) and 8% (n=5) had resistant disease. The OS rate at 4, 6 years was 19%. DFS rate at 4, 5 years was 28%. Conclusion: In univariate analysis, immunophenotype (Burkitt, B- or T-ALL), ECOG performance status (≤1 or >1) and age (≤ 30 or other) found that related to overall survival. In multivariate analysis, age (p=0.018) and ECOG performance status (p=0.010) found that associated with overall survival.
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Abstract (Original Language): 
GiriĢ: Modern kemoterapi protokolleri ile tedavi edilen akut lenfoblastik lösemili (ALL) hastaların prognozu çeĢitli değiĢkenlere bağlıdır. Bu risk faktörlerinin belirlenmesi remisyondan sonraki dönemde tedavinin belirlenmesi için oldukça önemlidir. Biz burada, eriĢkin ALL hastalarındaki klinik özellikleri ve prognostik faktörleri belirlemeye çalıĢtık. Gereç ve yöntem: Merkezimizde Ocak 2003 ile Aralık 2008 tarihleri arasında yeni tanı konulan 65 eriĢkin ALL hastasının retrospektif değerlendirmesi yapılmıĢtır. Median yaĢ 35,6 (dağılım 16–72) ve hastaların %70‟i B-ALL, %20‟si T-ALL ve %10‟nu da Burkitt ALL idi. 32 hasta Hiper-CVAD, 25 hasta CALGB–8811, 3 hasta HAM (yüksek doz sitarabin + mitoksantron) ve birer hasta MOPP, St Jude Total XIII ve CHOP21 protokolleri almıĢlardı. Bir hasta CALGB8811 protokolü alıp remisyona girdiği halde karaciğer toksisitesi nedeni ile tedavisine Hiper-CVAD protokolü ile devam edilmiĢti. Bir hastaya beyaz küre yüksekliği nedeni ile lökoferez ve hidroksiüre verilmiĢ, fakat kemoterapi baĢlanmadan kaybedilmiĢti. Bulgular: Hastaların ortalama izlem süresi 407 (0–1706) gün idi. Sitogenetik/moleküler genetik incelemelerde 1 hastada myc-oncogeni ile ilgili bozukluk, 9 hastada t(9;22), 2 hastada t(4;11) bulunmuĢtu. Hastaların indüksiyon kemoterapisine yanıt oranları; %60 (n=39) tam yanıt, %32 (n=21) eks, %8 (n=5) yanıtsız hastalık olarak belirlendi. 4,6 yıllık total sağkalım oranı %19 idi. 4,5 yıllık hastalıksız sağkalım oranı %28 idi. Sonuç: Tek değiĢkenli analizlerde total sağkalım ile iliĢkili bulunan parametreler hastalığın tipi (Burkitt, B- ya da T-ALL), ECOG performans durumu (≤1 ya da >1) ve yaĢ (≤ 30 ve diğer) idi. Çok değiĢkenli analiz yapıldığında yaĢ (p=0.018) ve ECOG performans durumu (p=0.010) total sağkalımı etkileyen değiĢkenler olarak bulundu.
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