YENİ TANILI ERİŞKİN AKUT LENFOBLASTİK LÖSEMİ HASTALARINDA TOTAL SAĞKALIMI ETKİLEYEN FAKTÖRLER

Abstract

Giriş: Modern kemoterapi protokolleri ile tedavi edilen akut lenfoblastik lösemili (ALL) hastaların prognozu çeşitli değişkenlere bağlıdır. Bu risk faktörlerinin belirlenmesi remisyondan sonraki dönemde tedavinin belirlenmesi için oldukça önemlidir. Biz burada, erişkin ALL hastalarındaki klinik özellikleri ve prognostik faktörleri belirlemeye çalıştık. Gereç ve yöntem: Merkezimizde Ocak 2003 ile Aralık 2008 tarihleri arasında yeni tanı konulan 65 erişkin ALL hastasının retrospektif değerlendirmesi yapılmıştır. Median yaş 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 almışlardı. Bir hasta CALGB8811 protokolü alıp remisyona girdiği halde karaciğer toksisitesi nedeni ile tedavisine Hiper-CVAD protokolü ile devam edilmişti. Bir hastaya beyaz küre yüksekliği nedeni ile lökoferez ve hidroksiüre verilmiş, fakat kemoterapi başlanmadan kaybedilmişti. Bulgular: Hastaların ortalama izlem süresi 407 (0–1706) gün idi. Sitogenetik/moleküler genetik incelemelerde 1 hastada myconcogeni ile ilgili bozukluk, 9 hastada t(9;22), 2 hastada t(4;11) bulunmuştu. 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 değişkenli analizlerde total sağkalım ile ilişkili bulunan parametreler hastalığın tipi (Burkitt, B- ya da T-ALL), ECOG performans durumu (≤1 ya da > 1) ve yaş (≤ 30 ve diğer) idi. Çok değişkenli analiz yapıldığında yaş (p=0.018) ve ECOG performans durumu (p=0.010) total sağkalımı etkileyen değişkenler olarak bulundu.

Keywords

• Erişkin akut lenfoblastik lösemi, total sağkalım, hastalıksız sağkalım

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