Akut lenfoblastik lösemi olgularının klinik seyir ve tedavi cevabı yönünden retrospektif değerlendirilmesi: Tek merkez deneyimi

Öz

Amaç: Merkezimize başvuran erişkin akut lenfoblastik lösemi (ALL) hastalarının demografik özelliklerini, sağkalım verilerini incelemek ve prognoza etkili faktörleri belirlemek amaçlanmıştır. Gereç ve Yöntemler: 2009-2018 yılları arasında merkezimize başvuran ve ALL tanısı konulan hastalar retrospektif olarak incelendi. Veriler ışığında hastaların laboratuvar verileri, uygulanan tedaviler, tedaviye yanıt oranları, genel ve hastalıksız sağkalım oranları hesaplandı. Bulgular: Çalışmamıza toplamda 30 hasta (16 erkek ve 14 kadın) dahil edildi. Hastaların 5'i T hücreli, 23’ü B hücreli ve 2'si bifenotipik alt tipe sahipti. Ortalama takip süresi ortanca 31,5 ay (1-90 ay) olarak bulundu. Hastalarda genel sağkalım (OS) 26 ay (1-87ay), hastalıksız sağkalım (PFS) 21.5 ay (13-84 ay) idi. Sonuç: Tanı ve takipte ALL hastalarının risk grubunun prognostik faktörler ışığında doğru olarak belirlenmesi ve tedavi yaklaşımının hastaya yönelik belirlenmesi prognoz açısından önemlidir. Her hastada yaşına, performans durumuna, prognostik faktörlerine uygun olabilecek bir tedavi yaklaşımı uygulanmalıdır.

Anahtar Kelimeler

• akut lenfoblastik lösemi
• erişkin
• sağkalım

Retrospective analysis of prognosis and treatment response ın acute lymphoblastic leukemia patıents: Single center experience

Abstract

Aim: The aim of the study is analyze the characteristics, survival and the prognostic factors of adult acute lymphoblastic leukemia (ALL) patients admitted to our center. Material Methods: The ALL patients who admitted to our center between 2009 and 2018 and were were retrospectively analyzed. The data of laboratory and treatment approaches of patients were reviewed. Also the response rates, overall and disease-free survival rates were calculated. Results: Totally thirty ALL patients (16 male,14 female) were included. Subtypes of patients were T-cell (5 patients), B-cell (23 patients) and biphenotypic (2 patients) ALL. During median 31.5 months (1-90 months) of follow-up time, overall survival (OS) was 26 months (1-87 months) and progression free survival (PFS) was 21.5 months (13-84 months). Conclusion: Determine of prognostic risk factors of ALL patients is important during treatment decision. The treatment approaches should be assessed according to age, performance status and prognostic risk profile for each patient.

Keywords

• acute lymphoblastic leukemia
• adult
• survival

Kaynakça

1. 1.Ward E, DeSantis C, Robbins A, Kohler B, Jemal A. Childhood and adolescent cancer statistics, 2014. CA Cancer J Clin 2014; 64: 83-103.
2. 2. Bhojwani D, Yang JJ, Pui CH. Biology of childhood acute lymphoblastic leukemia. Pediatr Clin North Am 2015; 62: 47-60.
3. 3. Swerdlow SH, Campo E, Pileri SA, Harris NL, Stein H, Siebert R et al. The 2016 revision of the World Health Organization classification of lymphoid neoplasms. Blood 2016; 127: 2375-90.
4. 4. National Comprehensive Cancer Network. Acute lymphoid leukemia (version 2.2015).
5. 5. Redaelli A, Laskin BL, Stephens JM, Botteman MF, Pashos CL. A systematic literature review of the clinical and epidemiological burden of acute lymphoblastic leukaemia (ALL). Eur J Cancer Care 2005; 14: 53-62.
6. 6. Dores GM, Devesa SS, Curtis RE, Linet MS, Morton LM. Acute leukemia incidence and patient survival among children and adults in the United States, 2001-2007. Blood 2012; 119: 34-43.
7. 7. Sive JI, Buck G, Fielding A, Lazarus HM, Litzow MR, Luger S et al. Outcomes in older adults with acute lymphoblastic leukaemia (ALL): results from the international MRC UKALL XII/ECOG2993 trial. Br J Haematol 2012; 157: 463-71.
8. 8. Jabbour E, O’Brien S, Konopleva M, Kantarjian H. New insights into the pathophysiology and therapy of adult acute lymphoblastic leukemia. Cancer 2015; 121: 2517-28.

9. 9. Jemal A, Tiwari RC, Murray T, Ghafoor A, Samuels A, Ward E et al. American Cancer Society Cancer Statistics. CA Cancer J Clin 2004; 54: 8-29.
10. 10. Hoelzer D. Treatment of acute lymphoblastic leukemia. Semin Hematol 1994; 31: 1-15.
11. 11. Gottlieb AJ, Weinberg V, Ellison RR, Henderson ES, Terebelo H, Rafla S et al. Efficiacy of daunorubicin in the therapy of adult acute lymphoblastic leukemia: A prospective randomized trial by Cancer and Leukemia Group B. Blood 1984; 64: 267-74
12. 12. Larson RA, Dodge RK, Burns CP, Lee EJ, Stone RM, Schulman P et al. A five-drug remission induction regimen with intensive consolidation for adults with acute lymphoblastic leukemia: Cancer and Leukemia Group B study 8811. Blood 1995; 85: 2025-37.
13. 13. Gökbuget N. How I treat older patients with ALL. Blood 2013; 122: 1366-75.
14. 14. O’Brien S, Thomas DA, Ravandi F, Faderl S, Pierce S, Kantarjian H. Results of the hyperfractionated cyclophosphamide, vincristine, doxorubicin, and dexamethasone regimen in elderly patients with acute lymphocytic leukemia. Cancer 2008; 113: 2097-101.
15. 15. Laport RP, Larson RA. Treatment of adult acute lymphoblastic leukemia. Semin Oncol 1997; 24: 70-82.
16. 16. Bassan R, Spinelli O, Oldani E, Intermesoli T, Tosi M, Peruta B, et al. Improved risk classification for risk-specific therapy based on the molecular study of minimal residual disease (MRD) in adult acute lymphoblastic leukemia (ALL). Blood 2009; 113: 4153- 62.
17. 17. Dhédin N, Huynh A, Maury S, Tabrizi R, Beldjord K, Asnafi V et al; GRAALL Group. Role of allogeneic stem cell transplantation in adult patients with Ph-negative acute lymphoblastic leukemia. Blood 2015; 125: 2486-96.
18. 18. Gökbuget N, Kneba M, Raff T, Trautmann H, Bartram CR, Arnold R et al; German Multicenter Study Group for Adult Acute Lymphoblastic Leukemia. Adult patients with acute lymphoblastic leukemia and molecular failure display a poor prognosis and are candidates for stem cell transplantation and targeted therapies. Blood 2012; 120: 1868-76.
19. 19. Ribera JM, Oriol A, Morgades M et al. Treatment of highrisk Philadelphia chromosome-negative acute lymphoblastic leukemia in adolescents and adults according to early cytologic response and minimal residual disease after consolidation assessed by flow cytometry: final results of the PETHEMA ALL-AR-03 trial. J Clin Oncol 2014; 32: 1595-1604.
20. 20. Brüggemann M, Gökbuget N, Kneba M. Acute lymphoblastic leukemia: monitoring minimal residual disease as a therapeutic principle. Semin Oncol 2012; 39: 47-57.