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YENİ TANILI ERİŞKİN AKUT LENFOBLASTİK LÖSEMİ HASTALARINDA TOTAL SAĞKALIMI ETKİLEYEN FAKTÖRLER

Yıl 2011, Cilt: 74 Sayı: 1, 7 - 12, 10.11.2011

Songül Şerefhanoğlu Yahya Büyükaşık Salih Aksu Hakan Göker Nilgün Sayınalp Deniz Çetiner İbrahim Haznedaroğlu Osman Özcebe

Öz

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.

Anahtar Kelimeler

Erişkin akut lenfoblastik lösemi total sağkalım hastalıksız sağkalım

Kaynakça

  • Baak U, Gokbuget N, Orawa H, Schwartz S, Hoelzer D, Thiel E, Burmeister T. Thymic adult T-cell acute lymphoblastic leukemia stratified in Standard- and high– risk group by aberrant HOX11L2 expression: experience of the German multicenter ALL study group. Leukemia. 2008; 22 :1154-1160.
  • Baldus CD, Burmeister T, Martus P, Schwartz S, Gokbuget N, Bloomfield CD, Hoelzer D, Thiel D, Hofmann WK. High expression of the ETS transcription factor ERG predicts aderse outcome in acute T- lymphoblastic leukemia in adults. Journal of Clinical Oncology. 2006;24 :4714-4720.
  • Cortes J, Fayad L, O‟Brein S, Keating M, Kantarjian H. Persistence of peripheral blood and bone marrow blats during remission induction in adult acute lymphoblastic leukemia confers a poor prognosis depending on treatment intensity. Clin Cancer Res. 1999;5 :2491- 2497.
  • Hoelzer DR. Therapy of the newly diagnosed adult with acute lymphoblastic leukemia. Hematol Oncol Clin North Am. 1993;7 :139–160.
  • Hussein KK, Dahlberg S, Head D, Waddell CC, Dabich L, Weick JK, Morrison F, Saiki JH, Metz E, Rivkin SE. Treatment of acute lymphoblastic leukemia in adults with maintenance chemotherapy. Blood. 1989;73 :57–63.
  • Kantarjian H, Thomas D, O'Brien S, Cortes J, Giles F, Jeha S, Bueso-Ramos CE, Pierce S, Shan J, Koller C, Beran M, Keating M, Freireich EJ. Long-term follow- up results of hyperfractioned cyclophosphamide, vincristine, doxorubicin, and dexamethasone (Hyper- CVAD), a dose-intensiveregimen, in adult acute lymphoblastic leukemia. Cancer. 2004;101 :2788-2801.
  • Kantarjian HM, Walters RS, Keating MJ, Smith TL, O'Brien S, Estey EH, Huh YO, Spinolo J, Dicke K, Barlogie B. Results of the vincristine, doxorubicin, and dexamethasone regimen in adults with standard- and high-risk acute lymphocytic leukemia. J Clin Oncol. 1990;8 :994–1004.
  • Larson RA, Dodge RK, Burns CP, Lee EJ, Stone RM, Schulman P, Duggan D, Davey FR, Sobol RE, Frankel SR. A five-drug remission induction regimen with intensive lymphoblastic leukemia: Cancer and Leukemia Group B Study 8811. Blood. 1995;85:2025-2037. with acute
  • Larson RA. Recent clinical trials in acute lymphoblastic leukeima by the Cancer and Leukemia Group B. Hematol Oncol Clin North Am. 2000;14 :1367–1379.
  • Le QH, Thomas X, Ecochard R, Iwaz J, Lhéritier V, Michallet M, Fiere D. Initial and late prognostic factors to predict survival in adult acute lymphoblastic leukaemia. Eur J Haematol. 2006;77 :471-479.
  • Linker CA, Levitt LJ, O‟Donnell M, Forman SJ, Ries CA. Treatment of adult acute lymphoblastic leukemia with intensive cyclical chemotherapy: A follow-up report. Blood. 1991;78 :2814–2822.
  • Moorman AV, Harrison CJ, Buck GA, Richards SM, Secker-Walker LM, Martineau M, Vance GH, Cherry AM,Higgins RR, Fielding AK, Foroni L, Paietta E, Tallman MS, Litzow MR, Wiernik PH, Rowe JM, Goldstone AH, Dewald GW; Adult Leukaemia Working Party, Medical Research Council/National Cancer Research Institute. Karyotype is an independent prognostic factor in adult acute lymphoblastic leukemia (ALL): analysis of cytogenetic data from patients treated on the Medical Research Council (MRC) UKALL-XII/Eastern Cooperative Oncology Group (ECOG)2993 trial. Blood. 2007;109 :3189-3197.
  • Nowak-Gottl U, Ahlke E, Fleischhack G, Schwabe D, Schobess R, Schumann C, Junker R. Thromboembolic events in children with acute lymphoblastic leukemia (BFM protocols): prednisone versus dexamethasone administration. Blood. 2003;101 :2529–2533.
  • Pullarkat V, Slovak MI, Kopecky KJ, Forman SJ and Appelbaum FR. Impact of cytogenetics on the outcome of adult acute lymphoblastic leukemia: results of Southwest Oncology Group 9400 study. Blood. 2008;111 :2563-2572.
  • Rowe JM, Buck G, Burnett AK, Chopra R, Wiernik PH, Richards SM, Lazarus HM, Franklin IM, Litzow MR, Ciobanu N, Prentice HG, Durrant J, Tallman MS, Goldstone AH; ECOG; MRC/NCRI Adult Leukemia Working Party. Induction therapy for adults with acute lymphoblastic leukemia: results of more than 1500 patients from the international ALL trial: MRC UKALL XII/ECOG E2993. Blood. 2005;106 :3760- 3767.
  • Thomas X, Le QH. Prognostic factors in adult acute lymphoblastic leukemia. Hematology. 2003;8 :233- 242.
  • Thomas X, Danaila C, Le QH, Sebban C, Troncy J, Charrin C, Liheritier V, Michallet M, Magaud JP, Fiere D. Long-term follow-up of patients with newly diagnosed adult acute lymphoblastic leukemia: A single institution experience of 378 consecutive patients over a 21-year period. Leukemia. 2001;15 :1811-1822.
  • Taylor PRA, Reid MM, Brown N, Hamilton PJ, Proctor SJ. Acute lymphoblastic leukemia in patients aged 60 years an over: a population-based study if incidence and outcome. Blood. 1992;80 :1813-1817.
  • Xu W, Li JY, Qian SX, Wu HX, Lu H, Chen LJ, Zhang SJ, Lu RL, Sheng RL. Outcome of treatment with Hyper-CVAD regimen in Chinese patients with acute lymphocytic leukemia. Leuk Res. 2008;32 :930-935.
  • Verma A, Stock W. Management of adult acute lymphoblastic leukemia: moving toward a risk-adapted approach. Curr Opin Oncol. 2001;13 :14-20.

Yıl 2011, Cilt: 74 Sayı: 1, 7 - 12, 10.11.2011

Songül Şerefhanoğlu Yahya Büyükaşık Salih Aksu Hakan Göker Nilgün Sayınalp Deniz Çetiner İbrahim Haznedaroğlu Osman Özcebe

Öz

Kaynakça

  • Baak U, Gokbuget N, Orawa H, Schwartz S, Hoelzer D, Thiel E, Burmeister T. Thymic adult T-cell acute lymphoblastic leukemia stratified in Standard- and high– risk group by aberrant HOX11L2 expression: experience of the German multicenter ALL study group. Leukemia. 2008; 22 :1154-1160.
  • Baldus CD, Burmeister T, Martus P, Schwartz S, Gokbuget N, Bloomfield CD, Hoelzer D, Thiel D, Hofmann WK. High expression of the ETS transcription factor ERG predicts aderse outcome in acute T- lymphoblastic leukemia in adults. Journal of Clinical Oncology. 2006;24 :4714-4720.
  • Cortes J, Fayad L, O‟Brein S, Keating M, Kantarjian H. Persistence of peripheral blood and bone marrow blats during remission induction in adult acute lymphoblastic leukemia confers a poor prognosis depending on treatment intensity. Clin Cancer Res. 1999;5 :2491- 2497.
  • Hoelzer DR. Therapy of the newly diagnosed adult with acute lymphoblastic leukemia. Hematol Oncol Clin North Am. 1993;7 :139–160.
  • Hussein KK, Dahlberg S, Head D, Waddell CC, Dabich L, Weick JK, Morrison F, Saiki JH, Metz E, Rivkin SE. Treatment of acute lymphoblastic leukemia in adults with maintenance chemotherapy. Blood. 1989;73 :57–63.
  • Kantarjian H, Thomas D, O'Brien S, Cortes J, Giles F, Jeha S, Bueso-Ramos CE, Pierce S, Shan J, Koller C, Beran M, Keating M, Freireich EJ. Long-term follow- up results of hyperfractioned cyclophosphamide, vincristine, doxorubicin, and dexamethasone (Hyper- CVAD), a dose-intensiveregimen, in adult acute lymphoblastic leukemia. Cancer. 2004;101 :2788-2801.
  • Kantarjian HM, Walters RS, Keating MJ, Smith TL, O'Brien S, Estey EH, Huh YO, Spinolo J, Dicke K, Barlogie B. Results of the vincristine, doxorubicin, and dexamethasone regimen in adults with standard- and high-risk acute lymphocytic leukemia. J Clin Oncol. 1990;8 :994–1004.
  • Larson RA, Dodge RK, Burns CP, Lee EJ, Stone RM, Schulman P, Duggan D, Davey FR, Sobol RE, Frankel SR. A five-drug remission induction regimen with intensive lymphoblastic leukemia: Cancer and Leukemia Group B Study 8811. Blood. 1995;85:2025-2037. with acute
  • Larson RA. Recent clinical trials in acute lymphoblastic leukeima by the Cancer and Leukemia Group B. Hematol Oncol Clin North Am. 2000;14 :1367–1379.
  • Le QH, Thomas X, Ecochard R, Iwaz J, Lhéritier V, Michallet M, Fiere D. Initial and late prognostic factors to predict survival in adult acute lymphoblastic leukaemia. Eur J Haematol. 2006;77 :471-479.
  • Linker CA, Levitt LJ, O‟Donnell M, Forman SJ, Ries CA. Treatment of adult acute lymphoblastic leukemia with intensive cyclical chemotherapy: A follow-up report. Blood. 1991;78 :2814–2822.
  • Moorman AV, Harrison CJ, Buck GA, Richards SM, Secker-Walker LM, Martineau M, Vance GH, Cherry AM,Higgins RR, Fielding AK, Foroni L, Paietta E, Tallman MS, Litzow MR, Wiernik PH, Rowe JM, Goldstone AH, Dewald GW; Adult Leukaemia Working Party, Medical Research Council/National Cancer Research Institute. Karyotype is an independent prognostic factor in adult acute lymphoblastic leukemia (ALL): analysis of cytogenetic data from patients treated on the Medical Research Council (MRC) UKALL-XII/Eastern Cooperative Oncology Group (ECOG)2993 trial. Blood. 2007;109 :3189-3197.
  • Nowak-Gottl U, Ahlke E, Fleischhack G, Schwabe D, Schobess R, Schumann C, Junker R. Thromboembolic events in children with acute lymphoblastic leukemia (BFM protocols): prednisone versus dexamethasone administration. Blood. 2003;101 :2529–2533.
  • Pullarkat V, Slovak MI, Kopecky KJ, Forman SJ and Appelbaum FR. Impact of cytogenetics on the outcome of adult acute lymphoblastic leukemia: results of Southwest Oncology Group 9400 study. Blood. 2008;111 :2563-2572.
  • Rowe JM, Buck G, Burnett AK, Chopra R, Wiernik PH, Richards SM, Lazarus HM, Franklin IM, Litzow MR, Ciobanu N, Prentice HG, Durrant J, Tallman MS, Goldstone AH; ECOG; MRC/NCRI Adult Leukemia Working Party. Induction therapy for adults with acute lymphoblastic leukemia: results of more than 1500 patients from the international ALL trial: MRC UKALL XII/ECOG E2993. Blood. 2005;106 :3760- 3767.
  • Thomas X, Le QH. Prognostic factors in adult acute lymphoblastic leukemia. Hematology. 2003;8 :233- 242.
  • Thomas X, Danaila C, Le QH, Sebban C, Troncy J, Charrin C, Liheritier V, Michallet M, Magaud JP, Fiere D. Long-term follow-up of patients with newly diagnosed adult acute lymphoblastic leukemia: A single institution experience of 378 consecutive patients over a 21-year period. Leukemia. 2001;15 :1811-1822.
  • Taylor PRA, Reid MM, Brown N, Hamilton PJ, Proctor SJ. Acute lymphoblastic leukemia in patients aged 60 years an over: a population-based study if incidence and outcome. Blood. 1992;80 :1813-1817.
  • Xu W, Li JY, Qian SX, Wu HX, Lu H, Chen LJ, Zhang SJ, Lu RL, Sheng RL. Outcome of treatment with Hyper-CVAD regimen in Chinese patients with acute lymphocytic leukemia. Leuk Res. 2008;32 :930-935.
  • Verma A, Stock W. Management of adult acute lymphoblastic leukemia: moving toward a risk-adapted approach. Curr Opin Oncol. 2001;13 :14-20.
Toplam 20 adet kaynakça vardır.

Ayrıntılar

Birincil Dil Türkçe
Bölüm Klinik Araştırma
Yazarlar

Songül Şerefhanoğlu Bu kişi benim

Yahya Büyükaşık Bu kişi benim

Salih Aksu Bu kişi benim

Hakan Göker Bu kişi benim

Nilgün Sayınalp Bu kişi benim

Deniz Çetiner Bu kişi benim

İbrahim Haznedaroğlu Bu kişi benim

Osman Özcebe Bu kişi benim

Yayımlanma Tarihi 10 Kasım 2011
Gönderilme Tarihi 10 Kasım 2011
Yayımlandığı Sayı Yıl 2011 Cilt: 74 Sayı: 1

Kaynak Göster

APA Şerefhanoğlu, S., Büyükaşık, Y., Aksu, S., Göker, H., vd. (2011). YENİ TANILI ERİŞKİN AKUT LENFOBLASTİK LÖSEMİ HASTALARINDA TOTAL SAĞKALIMI ETKİLEYEN FAKTÖRLER. Journal of Istanbul Faculty of Medicine, 74(1), 7-12.
AMA Şerefhanoğlu S, Büyükaşık Y, Aksu S, Göker H, Sayınalp N, Çetiner D, Haznedaroğlu İ, Özcebe O. YENİ TANILI ERİŞKİN AKUT LENFOBLASTİK LÖSEMİ HASTALARINDA TOTAL SAĞKALIMI ETKİLEYEN FAKTÖRLER. İst Tıp Fak Derg. Kasım 2011;74(1):7-12.
Chicago Şerefhanoğlu, Songül, Yahya Büyükaşık, Salih Aksu, Hakan Göker, Nilgün Sayınalp, Deniz Çetiner, İbrahim Haznedaroğlu, ve Osman Özcebe. “YENİ TANILI ERİŞKİN AKUT LENFOBLASTİK LÖSEMİ HASTALARINDA TOTAL SAĞKALIMI ETKİLEYEN FAKTÖRLER”. Journal of Istanbul Faculty of Medicine 74, sy. 1 (Kasım 2011): 7-12.
EndNote Şerefhanoğlu S, Büyükaşık Y, Aksu S, Göker H, Sayınalp N, Çetiner D, Haznedaroğlu İ, Özcebe O (01 Kasım 2011) YENİ TANILI ERİŞKİN AKUT LENFOBLASTİK LÖSEMİ HASTALARINDA TOTAL SAĞKALIMI ETKİLEYEN FAKTÖRLER. Journal of Istanbul Faculty of Medicine 74 1 7–12.
IEEE S. Şerefhanoğlu, Y. Büyükaşık, S. Aksu, H. Göker, N. Sayınalp, D. Çetiner, İ. Haznedaroğlu, ve O. Özcebe, “YENİ TANILI ERİŞKİN AKUT LENFOBLASTİK LÖSEMİ HASTALARINDA TOTAL SAĞKALIMI ETKİLEYEN FAKTÖRLER”, İst Tıp Fak Derg, c. 74, sy. 1, ss. 7–12, 2011.
ISNAD Şerefhanoğlu, Songül vd. “YENİ TANILI ERİŞKİN AKUT LENFOBLASTİK LÖSEMİ HASTALARINDA TOTAL SAĞKALIMI ETKİLEYEN FAKTÖRLER”. Journal of Istanbul Faculty of Medicine 74/1 (Kasım 2011), 7-12.
JAMA Şerefhanoğlu S, Büyükaşık Y, Aksu S, Göker H, Sayınalp N, Çetiner D, Haznedaroğlu İ, Özcebe O. YENİ TANILI ERİŞKİN AKUT LENFOBLASTİK LÖSEMİ HASTALARINDA TOTAL SAĞKALIMI ETKİLEYEN FAKTÖRLER. İst Tıp Fak Derg. 2011;74:7–12.
MLA Şerefhanoğlu, Songül vd. “YENİ TANILI ERİŞKİN AKUT LENFOBLASTİK LÖSEMİ HASTALARINDA TOTAL SAĞKALIMI ETKİLEYEN FAKTÖRLER”. Journal of Istanbul Faculty of Medicine, c. 74, sy. 1, 2011, ss. 7-12.
Vancouver Şerefhanoğlu S, Büyükaşık Y, Aksu S, Göker H, Sayınalp N, Çetiner D, Haznedaroğlu İ, Özcebe O. YENİ TANILI ERİŞKİN AKUT LENFOBLASTİK LÖSEMİ HASTALARINDA TOTAL SAĞKALIMI ETKİLEYEN FAKTÖRLER. İst Tıp Fak Derg. 2011;74(1):7-12.

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